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Pathophysiology: Introduction to Neuropsychiatry
The document provides an overview of neurological and psychiatric disorders, contrasting the two fields through their historical foundations, diagnostic systems, and examples of various conditions. It discusses the evolution of classification systems like the ICD and DSM, highlights significant figures such as Philippe Pinel and Jean Martin Charcot, and addresses issues related to diagnosis and the genetic basis of disorders like schizophrenia. Additionally, it presents insights from neurobiology and animal models used in research to understand these conditions.
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Pathophysiology: Introduction to Neuropsychiatry
- 1. Introduction to Neurological& Psychiatric Disorders Brian J. Piper, Ph.D., M.S. October 16, 2012
- 2. Learning objectives Pharmacy studentsshould be able to: 1. Compare and contrast psychiatry & neurology (historical figures & diagnostic systems). 2. Provide examples of animal models of human neurobehavioral conditions. 3. Evaluate evidence of neurobiological substrates of psychiatric conditions.
- 3. Neurology Psychiatry founder Jean Martin Charcot Philippe Pinel diagnostic system International Diagnostic & Classification Statistical of Diseases (ICD) Manual (DSM) examples epilepsy, migraine, MS/ALS, depression, schizophrenia, Parkinson’s sleep, dementia, autism pathophysiology moderate low laboratory tests common uncommon development of moderate moderate animal models (Parkinson’s, migraine) (drug addiction, schiz)
- 4. Father of Psychiatry:Philippe Pinel • moral treatment • classification: 4 Tony Robert-fleury (1876 ): Philippe Pinel releasing 1745 - 1826 lunatics from their chains at the Salpetriere asylum for women in Paris.
- 5. Father of Neurology:Jean Charcot • Described: – ALS – Multiple Sclerosis – Parkinson’s Disease – Huntington’s disease – Tourette syndrome
- 6. International Classification ofDiseases • UN/WHO • International List of Causes of Death 1: 1900 • International Statistical Classification of Diseases 6: 1949 • ICD-10: 1994 • ICD-11: 2015 http://www.who.int/classifications/icd/en/HistoryOfICD.pdf
- 7. Diagnostic & Statistical Manual of Mental Disorders (DSM) • Published by American Psychiatric Association • DSM-I: 1952: consists of 106 mental disorders • DSM-II: 1968: psychodynamic • DSM-III: 1980: descriptive, removal of homosexuality • DSM-IV: 1994: 297 disorders • DSM-5: 2013: ≈300 disorders!
- 8. Major Depressive Disorder • At least one: • At least five: – sad mood – ↑/↓sleeping – anhedonia – psychomotor agitation/retardation – loss of energy – weight loss – excessive guilt • Symptoms are present – thoughts of nearly every day for at death/suicide least 2 weeks. Kring et al. (2012). Abnormal Psychology, p. 134.
- 10. Criticisms of DSM • economic conflicts of interest • too subjective (interview, not laboratory based) • qualitative or quantitative • comorbidity (anxiety/depression; anorexia/bulimia) • reliable • valid – out: Asperger’s, Catatonic Schizophrenia – in: Premenstrual Dysphoric Disorder
- 11. Rosenhan Study • 8 pseudopatients show up at psychiatric facilities (12) with one symptom (hearing voices) • all diagnosed with schizophrenia • institutionalized for 7 -52 days • patients, but not staff, were suspicious Rosenhan, D. L. (1973). On being sane in insane places. Science, 179, 250-258.
- 12. Accuracy of Diagnosis Decision • 8 healthy pseduo-patients presented to SCZ- SCZ+ 12 psychiatric hospitals with complaint SCZ- Correct Type I of hearing voices Reality Diagnosis error • Acted normal but 11 diagnosed as schizophrenic SCZ+ Type II Correct error Diagnosis • Fellow patients, but not staff, were suspicious • Released after 7-52 days (mean = 19) 1929-2012 Rosenhan (1973). Science, 179, 250-258.
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- 14. Genain Sisters “Genain”: Greek “dire birth”, born 1930, all hospitalized for schizophrenia by early 20s, probability = 1.5 billion Nora: intermediate (jobs, no family) Iris: intermediate (jobs, no family) Myra: secretary, married, 2 sons Hester: showed signs at age 11, institutionalized Genetics: identical Environment: identical (schizophrenic mom) Prenatal: ?
- 15. Genetics & Schizophrenia The likelihood of an individual suffering from schizophrenia is 50% if their identical twin has the disorder. 0 10 20 30 40 50 Identical Both parents Fraternal One parent Sibling Nephew or niece Unrelated
- 16. Genetics & Schizophrenia The following shows the prevalence of schizophrenia in identical twins as seen in different countries.
- 17. Heritability of Psychiatric Disorders British Medical Journal 1999; 319 : 37
- 18. Structural Changes &Depression • Rat research indicate that persistent increases in cortisol are toxic to hippocampal neurons. • Studies examining the volume of the hippocampus in MDD were inconsistent. • A meta-analysis showed that the left (-4.5%) and right hippocampus (-4.0%) showed reductions. Cole et al. (2011). Journal of Affective Disorders, 134, 483-487.
- 19. Brain Morphology &Schizophrenia Some schizophrenia patients exhibit morphological changes in the brain like enlargement of fluid-filled ventricles. Both Photos: Courtesy of Daniel R. Weinberger, M.D., NIH-NIMH/ NSC
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- 21. Meta-Analysis • 58 studies Region (Left or Right) % of Control • 1,588 SCZ patients L Lateral Ventricle 130 R Lateral Ventricle 120 Gray Matter 96 White Matter 98 L Frontal Lobe 95 L Hippocampus 95 L Amygdala 91 L Thalamus 96 R Thalamus 96 Wright et al. (2000). American Journal of Psychiatry, 157, 16-25.
- 22. Concern: Cause orCorrelate? • Adult monkeys received typical (haloperidol) or * atypical (olanzapine) * antipsychotics for 2 years at doses similar to schizophrenics. • Gray matter in parietal cortex was examined. Konopaske et al. (2007). Neuropsychopharmacology, 32, 1216-1223.
- 23. Wisconsin Card SortingTest • Developed by Esta Berg in 1950s • Measures cognitive flexibility and perseverative behaviors (number, color, shape)
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- 25. Example Animal Models •Psychiatry: Forced Swim Test (depression) http://www.youtube.com/watch?v=Wq2dyNIL b5U • Neurology: Roto-rod (PD/motor function) http://www.youtube.com/watch?v=xNCWkA3 XlBQ
- 26. Current: Mental Health“Care” U.S. Patients in Psychiatric Hospitals, by year. U.S. Census, 2007.
Editor's Notes
- #2 Neurons in mouse brain (likely pyramidal).
- #5 Pinel did away with bleeding, purging, and blistering in favor of a therapy that involved close contact with and careful observation of patients. Pinel visited each patient, often several times a day, and took careful notes over two years. He engaged them in lengthy conversations. The actual removal of the shackles may have been done by someone else Jean-Baptiste Pussin(1745-1811), the superintendent.Pinel's classification of mental disorders included four basic types: melancholia, mania (insanity), dementia, and idiotism.
- #6 Charcot provided key descriptions of ALS/MS. He also promoted the otherwise obscure writings that led to (James) Parkinson’s Disease & (George) Huntington’s Disease.
- #7 The International Classification of Diseases is published by the World Health Organization (WHO) and used worldwide for morbidity and mortality statistics and reimbursement systems. In 1893, a French physician, Jacques (joc) Bertillon, introduced the Bertillon Classification of Causes of Death at a congress of the International Statistical Institute in Chicago. Many countries and cities adopted Dr. Bertillon’s system, which was based on the principle of distinguishing between general diseases and those localized to a particular organ or anatomical site, as was used by Paris for classifying deaths. Includes a 6 digit code for insurance reimbursement.The ICD-9 contained 17K codes for diseases & procedures. ICD-10 = 155K!
- #9 Loss of energy or change in appetite; feelings of worthlessness or excessive guilt; difficulty concentrating, thinking, or making decisions.
- #11 Reliability was a problem with the Rosenhan schizophrenia study.
- #12 The eight pseudopatients were a varied group. One was a psychology graduate student in his 20's and there were three psychologists, a pediatrician, a psychiatrist, a painter, and a housewife (5 male).35/118 patients were skeptical (e.g. you’re a journalist)0:37-3:30: http://www.youtube.com/watch?v=Kq-7uvVOoyk
- #18 An older school of thought for the origins of psychiatric disorders was poor parenting (e.g. “refrigerator mother” & autism).