This document discusses schizophrenia and affective disorders. It describes schizophrenia as a serious mental disorder characterized by disordered thoughts, delusions, and hallucinations. Positive symptoms include delusions and hallucinations, while negative symptoms include social withdrawal and lack of emotion. Schizophrenia has genetic and environmental causes and is associated with abnormalities in brain structure and dopamine activity. Affective disorders include major depressive disorder and bipolar disorder, which affect mood. They have genetic and physiological causes and treatments include antidepressants, lithium, ECT, and sleep deprivation therapies.
This presentation deals with pathophysiology of Parkinson's Disease.
Important headings, including normal physiology, etiological factors and clinical manifestations have been elucidated.
This presentation deals with pathophysiology of Parkinson's Disease.
Important headings, including normal physiology, etiological factors and clinical manifestations have been elucidated.
Parkinson's disease is a progressive nervous system disorder that affects movement. Symptoms start gradually, sometimes starting with a barely noticeable tremor in just one hand. Tremors are common, but the disorder also commonly causes stiffness or slowing of movement
Recent advances in the treatment of psychosesKarun Kumar
This presentation deals with atypical antipsychotics & new drugs in the pipeline (Clozapine, Risperidone, Olanzapine, Quetiapine, Ziprasidone, Aripiprazole, Second generation antipsychotics, atypical antipsychotics, Aspirin, Minocycline, Raloxifene, Estrogen, N-acetylcysteine). Introduction
Major psychiatric disorders Psychoses & affective disorders
Psychoses Disorders in which patients exhibit gross disturbances in their comprehension of reality as evidenced by false perception (hallucinations), false beliefs (delusions) and loss of contact with reality; schizophrenia most common form of psychosis (+ve n –ve symptoms)
Mostly concerned Abt –ve because poor prognosis , more difficult to treat, persist after positive symptoms have resolved
Mesolimbic Dopamine travels from the midbrain tegmental area to the nucleus accumbens. Increased activity in this pathway may cause delusions, hallucinations, and other so-called positive symptoms of schizophrenia.
Mesocortical pathways Decreased activity in the pathway that goes from the midbrain to the prefrontal lobe cortex can cause apathy, withdrawal, lack of motivation and pleasure, and other so-called negative symptoms of schizophrenia. Mesocortical dysfunction also disinhibits the mesolimbic pathway.
Nigrostriatal pathway from the substantia nigra to the striatum is involved in the coordination of body movements. Inhibition of this pathway causes the extrapyramidal side effects of antipsychotic drugs.
Tuberoinfundibular pathway from the hypothalamus to the pituitary inhibits the release of prolactin. Inhibition of this pathway leads to elevated serum prolactin levels.
2nd generation antipsychotics Clozapine, Risperidone, Olanazapine, Quetiapine, Ziprasidone, Aripiprazole (MOA, Dose, Brand name & A/E and receptor affinities)
Why do 1st gen. antipsychotics cause EPS & 2nd gen. do not? “Hit and run” hypothesis
Inflammation & schizophrenia
New drugs in pipeline Aspirin, Minocycline, Raloxifene, Estrogen, N-acetylcysteine (MOA and rationale of use)
Potential future targets of schizophrenia
On the occasion of National Epilepsy Day 2014, Dr. ES Krishnamoorthy introduced basic concepts of Epilepsy at the Epilepsy Knowledge Forum in Chennai organised by Neurokrish & Trimed and Sponsored Medall.
Schizophrenia is a psychotic condition characterized by a disturbance in thinking, emotions, volition and faculties in the presence of clear consciousness, which usually leads to social withdrawal
Parkinson's disease is a progressive nervous system disorder that affects movement. Symptoms start gradually, sometimes starting with a barely noticeable tremor in just one hand. Tremors are common, but the disorder also commonly causes stiffness or slowing of movement
Recent advances in the treatment of psychosesKarun Kumar
This presentation deals with atypical antipsychotics & new drugs in the pipeline (Clozapine, Risperidone, Olanzapine, Quetiapine, Ziprasidone, Aripiprazole, Second generation antipsychotics, atypical antipsychotics, Aspirin, Minocycline, Raloxifene, Estrogen, N-acetylcysteine). Introduction
Major psychiatric disorders Psychoses & affective disorders
Psychoses Disorders in which patients exhibit gross disturbances in their comprehension of reality as evidenced by false perception (hallucinations), false beliefs (delusions) and loss of contact with reality; schizophrenia most common form of psychosis (+ve n –ve symptoms)
Mostly concerned Abt –ve because poor prognosis , more difficult to treat, persist after positive symptoms have resolved
Mesolimbic Dopamine travels from the midbrain tegmental area to the nucleus accumbens. Increased activity in this pathway may cause delusions, hallucinations, and other so-called positive symptoms of schizophrenia.
Mesocortical pathways Decreased activity in the pathway that goes from the midbrain to the prefrontal lobe cortex can cause apathy, withdrawal, lack of motivation and pleasure, and other so-called negative symptoms of schizophrenia. Mesocortical dysfunction also disinhibits the mesolimbic pathway.
Nigrostriatal pathway from the substantia nigra to the striatum is involved in the coordination of body movements. Inhibition of this pathway causes the extrapyramidal side effects of antipsychotic drugs.
Tuberoinfundibular pathway from the hypothalamus to the pituitary inhibits the release of prolactin. Inhibition of this pathway leads to elevated serum prolactin levels.
2nd generation antipsychotics Clozapine, Risperidone, Olanazapine, Quetiapine, Ziprasidone, Aripiprazole (MOA, Dose, Brand name & A/E and receptor affinities)
Why do 1st gen. antipsychotics cause EPS & 2nd gen. do not? “Hit and run” hypothesis
Inflammation & schizophrenia
New drugs in pipeline Aspirin, Minocycline, Raloxifene, Estrogen, N-acetylcysteine (MOA and rationale of use)
Potential future targets of schizophrenia
On the occasion of National Epilepsy Day 2014, Dr. ES Krishnamoorthy introduced basic concepts of Epilepsy at the Epilepsy Knowledge Forum in Chennai organised by Neurokrish & Trimed and Sponsored Medall.
Schizophrenia is a psychotic condition characterized by a disturbance in thinking, emotions, volition and faculties in the presence of clear consciousness, which usually leads to social withdrawal
Antipsychotics, also known as neuroleptics,[1] are a class of psychotropic medication primarily used to manage psychosis (including delusions, hallucinations, paranoia or disordered thought), principally in schizophrenia but also in a range of other psychotic disorders.[2][3] They are also the mainstay together with mood stabilizers in the treatment of bipolar disorder.[4]
Antipsychotic
Drug class
Zyprexa.PNG
Olanzapine, an example of a second-generation (atypical) antipsychotic
Class identifiers
Synonyms
Neuroleptics, major tranquilizers[1]
Use
Principally: Schizophrenia, Schizoaffective disorder, Dementia, Tourette syndrome, Bipolar disorder, irritability in autism spectrum disorder
Clinical data
Drugs.com
Drug Classes
External links
MeSH
D014150
In Wikidata
Prior research has shown that use of any antipsychotic is associated with smaller brain tissue volumes,[5][6] including white matter reduction[7] and that this brain shrinkage is dose dependent and time dependent.[5][6] A more recent controlled trial suggests that second generation antipsychotics[8] combined with intensive psychosocial therapy[9] may potentially prevent pallidal brain volume loss in first episode psychosis.[10][7]
The use of antipsychotics may result in many unwanted side effects such as involuntary movement disorders, gynecomastia, impotence, weight gain and metabolic syndrome. Long-term use can produce adverse effects such as tardive dyskinesia, tardive dystonia, and tardive akathisia.
Prevention of these adverse effects is possible through concomitant medication strategies including use of beta-blockers. Currently, treatments for tardive diseases are not well established.
First-generation antipsychotics (e.g. chlorpromazine), known as typical antipsychotics, were first introduced in the 1950s, and others were developed until the early 1970s.[11] Second-generation antipsychotics, known as atypical antipsychotics, were introduced firstly with clozapine in the early 1970s followed by others (e.g. risperidone).[12] Both generations of medication block receptors in the brain for dopamine, but atypicals tend to act on serotonin receptors as well. Neuroleptic, originating from Greek: νεῦρον (neuron) and λαμβάνω (take hold of)—thus meaning "which takes the nerve"—refers to both common neurological effects and side
Depression is a mental disorder and has become most common in recent years. This slide or presentation deals with all types of aetiologies of depression, theories that are involved in development of depression, pathophysiology of drepression, various classes anti-depressant their pharmacology with the adverse events or effects. This also gives a brief note on difference between depression and sadness.
Depression by Dr Iqra Osman Abdullahi.MDiqra osman
DEPRESSION
Dr.Iqra Osman
1.CONTENTS
INTRODUCTION
DEFINITION
TYPES OF DEPRESSION
EPIDEMIOLOGY
ETIOLOGY
PATHOPHYSIOLOGY
CLINICAL MANIFESTATIONS
DIAGNOSIS
INVESTIGATIONS
TREATMENT
CONCLUSION
REFERENCES
2.INTRODUCTION
Depression is a affective disorders.
Affective disorders : mental illnesses characterized by pathological changes in mood.
Depression : pathologically depressed mood
3.DEFINITION
DEPRESSION (By WHO) : Common mental disorder that presents with depressed mood, loss of interest or pleasure, feelings of guilt or low self- worth, disturbed sleep or appetite, low energy, and poor concentration.
4.TYPES OF DEPRESSION
Major depressive disorder : recurrence of long episodes of low moods, or one extended episode that seems to be ‘never-ending.
Atypical depression
Post partum depression
Catatonic depression
Seasonal affective disorder
Melancholic depression
5.Manic depression (bipolar disorder)
Four ‘Episodes’ of Bipolar Disorder
depressive episode
manic episodes
hypomanic episode
mixed-mood states
6.Dysthymic depression
lasts a long time but involves less severe symptoms.
lead a normal life, but we may not be functioning well or feeling good
Situational depression
Psychotic depression
Endogenous depression
7.EPIDEMIOLOGY
Globally more than 350 million people of all ages suffer from depression. (WHO)
For the age group 15-44 major depression is the leading cause of disability in the U.S.
Women are nearly twice as likely to suffer from a major depressive disorder than men are.
With age the symptoms of depression become even more severe.
About thirty percent of people with depressive illnesses attempt suicide.
8.ETIOLOGY
Genetic cause
Environmental factors
Biochemical factors : Biochemical theory of depression postulates a deficiency of neurotransmitters in certain areas of the brain (noradrenaline, serotonin, and dopamine).
Dopaminergic activity : reduced in case of depression, over activity in mania.
Endocrine factors
- hypothyroidism, cushing’s syndrome etc
9.Abuse of Drugs or Alcohol
Hormone Level Changes
Physical illness and side effects of medications
DRUGS
Analgesics
Antidepressants
Antihypertensives
Anticonvulsants
Benzodiazipine withdrawal
Antipsychotics
10.PHYSICAL ILLNESS
Viral illness
Carcinoma
Neurological disorders
Thyroid disease
Multiple sclerosis
Pernicious anaemia
Diabetes
Systemic lupus erythematosus
Addison’s disease
11.PATHOPHYSIOLOGY
The Biogenic Amine Hypothesis
The Receptor Sensitivity Hypothesis
The Serotonin-only Hypothesis
The Permissive Hypothesis
The Electrolyte Membrane Hypothesis
The Neuroendocrine Hypothesis
12.The Biogenic Amine Hypothesis
- caused by a deficiency of monoamines, particularly noradrenaline and serotonin.
cannot explain the delay in time of onset of clinical relief of depression of up to 6-8 weeks.
The Receptor Sensitivity Hypothesis
depression is the result of a pathological alteration (supersensitivity and up-regulation) in receptor sites.
- TCAs or MAOIs causes desensitizatio
“Epilepsy and mental disorder are two states of illness of the very closest relationship; they represent identical pathological conditions in two different areas of the nervous system”
2. Schizophrenia
Description
Schizophrenia:
• A serious mental disorder characterized by:
Disordered thoughts
Delusions of persecution or grandeur
Hallucinations (mostly auditory)
Behaviors (withdrawn or detached, odd
movements))
3. Schizophrenia
Description
Positive symptom: (known by their presence)
• delusions, hallucinations, abnormal movements,
or thought disorders.
Negative symptom: (characterized by absence)
• social withdrawal, lack of affect, and reduced
motivation.
4. Schizophrenia
Possible Causes:
• Heritability is a statistical concept that estimates the
relative contribution of genetic factors to variability in a
trait (e.g., schizophrenia). It is not a measure of the
amount of contribution (e.g., 60% genes vs 40%
environment).
• Heritability: In its simplest form, if schizophrenia were
determined by a single dominant gene, about 75% of
children from schizophrenic parents would get it. If it was
recessive, about 50% would inherit the disorder. An
incidence less than 50% suggests that the disease is
determined by multiple genes and that only a
susceptibility is passed on.
5. Schizophrenia
Evidence for heritability
• Concordance rates:
Most studies suggest between 25-40%
concordance in identical twins and about 5-
20% in fraternal twins.
Clearly, the environment is an important
contribution.
6. Schizophrenia
Biochemical Causes
• Dopamine Hypothesis: schizophrenia is caused
by excessive dopamine activity in the mesolimbic
system.
• Supporting evidence: drug treatment,
amphetamine psychosis, treatment for
Parkinson’s disease
• Additional evidence: increased DA activity,
increased D3 & D4 receptors in mesolimbic
system,
7. Schizophrenia
Pharmacology of Schizophrenia
Chlorpromazine: A phenothiazine
• A “typical neuroleptic”; a nonspecific dopamine
receptor blocker; first prescribed
antischizophrenic drug.
Clozapine:
• An “atypical neuroleptic”; an antipsychotic drug
that blocks D4 receptors in the nucleus
accumbens. Little effect on D2 receptors
10. Schizophrenia
Consequences of Long-Term Drug Treatment of
Schizophrenia
Tardive dyskinesia:
• A movement disorder that can occur after
prolonged treatment with antipsychotic
medication, characterized by involuntary
movements of the face and neck.
Supersensitivity:
• The increased sensitivity of neurotransmitter
receptors; caused by damage to the afferent
axons or long-term blockage of neurotransmitter
release.
11. Schizophrenia
Evidence for neurological abnormalities Negative
symptoms
Schizophrenics with negative symptoms have
similar symptoms as those with fromtal lobe
damage.
• Frontal lobe size
• Ventrical size
• Cerebral gray matter decreases
14. Schizophrenia
Possible Causes of the Brain Abnormalities
Epidemiology:
• The study of the distribution and causes of
diseases in populations.
• Research suggest several environmental factors:
-Season of birth: greatest during winter months
-Viral epidemics: associated with viral diseases
-Latitude: increased incidence further from equator
-Prenatal malnutrition: ?
-Rh incompatibility: ?
-Maternal stress: ?
19. Schizophrenia
Degenerative process or sudden cell loss?
• Woods (1998) found that the cell loss in schizophrenic patients
appears to occur suddenly during late adolescence or early
adulthood. Schizophrenia is not a gradual degenerative disease like
Parkinson’s or Alzheimer’s diseases.
• Does not appear to involve cell death and ‘gliosis’ (replacement of
neural tissue by glia).
• Appears to involve loss of dendrites. Areas of tissue loss are
correlated with symptoms (temporal lobes with auditory
hallucinations, for example).
• The frontal cortex seems to be involved in most cases of
schizophrenia (hypofrontality)
20. Schizophrenia
The cause of schizophrenia now appears to be a
disturbance of normal brain development.
• Genetic predisposition may make individuals more
susceptible
• Obstetric complications may cause individuals without
genetic predisposition to develop schizophrenia
21. Schizophrenia
Hypofrontality (caused by a reduction in cell volume in the dorsolateral
frontal cortices) is associated with negative symptoms of schizophrenia.
Hypofrontality also results in an increase in dopamine activity in the
mesolimbic system which is associated with positive symptoms.
Dopamine hypothesis suggests that hypofrontality results in a disruption
of normal glutamate activity from the frontal cortex to the mesolimbic
system.
NMDA agonists cannot be used because they would cause seizures, but
glycine may be effective in treating schizophrenics since it is also an
NMDA agonist. Several studies have shown good results with negative
symptoms
22. Major Affective Disorders
Description
Major affective disorder:
• A serious mood disorder; includes major
depressive disorder and bipolar disorder.
• May effect as many as 5% of US population in a
given year. Perhaps as many as 25% over
lifetime.
23. Major Affective Disorders
Description
Major depressive disorder:
• A serious mood disorder that consists of
unremitting depression or periods of depression
that do not alternate with periods of mania.
Bipolar disorder:
• A serious mood disorder characterized by
cyclical periods of mania and depression.
24. Major Affective Disorders
Causes of Depression
Genetic contributions:
• Bipolar disorder may be caused by a single
dominant gene.
Location still not confirmed, but heritability
studies reveal strong link.
Major depressive disorder:
• Less likely caused by single gene than bipolar
disorder.
• Amine hypothesis: deficiencies in activity of one
or several amine neurotransmitter systems (NE,
SE)
25. Major Affective Disorders
Drug Treatment for Depression
Tricyclic antidepressants:
• A class of drugs used to treat depression; inhibits the
reuptake of norepinephrine and serotonin; named for the
specific molecular structure.
Amitriptyline (Elavil)
Monoamine oxidase inhibitors (MAOIs):
• Prevent degradation of NT in synapse.
phenelzine (Nardil)
Serotonin specific reuptake inhibitor (SSRI):
• A drug that inhibits the reuptake of serotonin without
affecting the reuptake of other neurotransmitters.
fluoxetine (Prozac)
26. Major Affective Disorders
Physiological Treatments
Lithium
• A chemical element; lithium carbonate is used to
treat bipolar disorder
Carbamazepine:
• An anticonvulsive drug (trade name: Tegretol)
that is used to treat seizures originating from a
focus, also used to treat mania in bipolar
disorder.
28. Major Affective Disorders
Physiological Treatments
Electroconvulsive therapy (ECT):
• A brief electrical shock that induces a seizure;
used therapeutically to alleviate severe
depression when medication is not effective.
Transcranial Magnetic Stimulation (TMS):
Magnetic field causes a weak electrical field and
electrical current within the brain. Has been
useful in some cases of depression.
30. Major Affective Disorders
Evidence of Brain Abnormalities
Brain abnormalities:
• Research suggests abnormalities in the
prefrontal cortex, basal ganglia, hippocampus,
thalamus, cerebellum, and temporal lobes.
• Some evidence suggests increased size of the
cerebral ventricles may suggest the loss of
neural tissue.
31. Major Affective Disorders
Evidence of Brain Abnormalities
Silent cerebral infarction (SCI):
• A small cerebrovascular accident (stroke) that
causes minor brain damage without producing
obvious neurological symptoms.
32. Major Affective Disorders
Role of Circadian Rhythms
REM Sleep Deprivation:
• Selective deprivation of REM sleep through EEG
monitoring, is one of the most effective
antidepressant treatments; suggests a close
relationship between REM sleep and mood.
• Antidepressant effects require several weeks of
deprivation.
36. Major Affective Disorders
Role of Circadian Rhythms
Total Sleep Deprivation:
• Total sleep deprivation has antidepressant effect
that are immediate; however, the procedure is
not very practical.
• Some individuals do not respond to total or
selective sleep deprivation.
37. Major Affective Disorders
Role of Zeitgebers
Seasonal affective disorder (SAD):
• A mood disorder characterized by depression,
lethargy, sleep disturbances, and craving for
carbohydrates during the winter months.
Summer depression:
• A mood disorder characterized by depression,
sleep disturbances, and loss of appetite.
38. Major Affective Disorders
Role of Zeitgebers
Phototherapy:
• Treatment of seasonal affective disorder by daily
exposure to bright light.