Understanding psychopathology: Mood disorders Professor Kraly, Colgate University, Spring 2011 Introduction to Psychology

Previous Class--Main Topics 1. How can neurochemistry of brain (different in males and females) be altered to treat psychopathology? 2. What are the fundamental principles of the effects of drugs upon brain and behavior? 3. Can therapeutic or recreational drugs have benefits without risks? Todays Main Topics 1. Can effective drug therapy reveal an underlying cause(s) of psychopathology? 2. Are diagnostic categories of psychopathology clearly defined? 3. What are the advantages of combining pharmacotherapy and psychotherapy? 4. Is a disorder such as depression likely caused by a single neurochemical abnormality? Mood disorders include:

anxiety disorders (e.g., obsessive compulsive disorder mania depression bipolar disorder (mania & depression) o Where a person swings from mania to depression o Environmental and heritable reasons

Graph Red bars a fraternal twins high Blue Bars, exact twins, show higher concordance rate for mood disorders Concordance Rate = What's the likelihood that the persons identical twin will be diagnosed with same disorder

Be careful about diagnostic categories. We are going to talk about them as if they are distinct diagnosable disorder. What psychologists have tried to do is make specific definitions for each, with subcategories etc. i.e. subcategories of depression They are all arbitrary, but at the same time very precise Ingredients can be the same, but amounts are different. A recipe can be arbitrary, but very precise. This correlates to the categorizing psychopathology. DSM criteria are operational definitions -- they are somewhat arbitrary and precise This leads to two facts about categories of psychopathology:

A diagnosis can be difficult to make. Make diagnosis based on arbitrary and precise definitions and symptoms. Diagnostic criteria should be constant. Sloppiness in criteria. Co-morbidity is common Possible to walk out with a diagnosis of two disorders, like anxiety and depression. This is the occurring together of two disorders. There are three symptoms in particular that co-occur between depression and anxiety. For example, insomnia, lack of focus, and something else. Table 17.5 Drugs Used to Treat Various Anxiety Disorders Antidepressants used to treat anxiety says a lot about the two disorders. For example Tricyclic antidepressants used to treat panic disorders, and Prozac, a seretonin uptake inhibitor is also used for anxiety disorders. This shows that symptoms overlap, and disorders not discretely different.

Graph: GABA + diazepam = increasing hyperpolarization that a normal neurotransmitter can perform Two perspectives on understanding abnormal behavior: 1. Abnormal behavior as part of a persons life story. a. the current abnormal behavior has antecedents and consequences. 2. Abnormal behavior as an expression of underlying causes. a. the current abnormal behavior is caused by physiological and neurochemical abnormalities.

Theoretical causes of a behavioral/mental disorder? Two factors: 1. Inherited physiological/neurochemical vulnerability that interacts with 2. Environmental factor/stressor (some life event) Most effective therapies combine talk and drug approaches. Why? Drug and talk may treat different components of various disorders. Combination of Talk Therapy and Medicine is Found to Ease Anxiety in Children Design of study: Subjects: children aged 7 - 17 suffering separation/social anxiety Duration: 12 weeks Drug: Zoloft--SSRI antidepressant Psychotherapy: Cognitive-Behavioral Therapy

Groups: 1. Zoloft (sertraline) only 2. cognitive-behavioral therapy only 3. Zoloft and cognitive-behavioral therapy 4. placebo with monitoring by psychiatrist Percentage of group showing much improvement: 55% - Zoloft only 60% - cognitive-behavioral therapy only 80% - Zoloft and cognitive-behavioral therapy 25% - placebo with monitoring by psychiatrist Interesting that it wasn't 0%, but not unusual for people to improve under placebo. 55% not SS compared to 60%. But 80% is SS. Regardless of what a drug is know for, if it helps people, it will be used. If you see more than half the people improving, you're doing good. Brain Scan Photography: Before Drug Treatment After Drug Treatment Neurochemical change from drug in the Caudate Before Behavioral Treatment After Behavioral Treatment In the same area, there is a comparable change in neurochemical composition without any drug intake.

Context: Schizophrenia (psychosis, break from reality) Patients recovered from schizophrenia return home to their families: Goal was to see rate of relapse after they go home. And they looked at family interaction. Some families present high expressed emotion; some families do not. (not constructive, smothering personality. Not necessarily unique to schizo families though). Some patients are maintained on anti-psychotic drug therapy; some are not. (Is it productive to give these?) Which of these recovered patients are more likely to relapse into schizophrenia? Relapse Rate Low EE (Expressed Emotion) 13% High EE (Expressed Emotion) 51%

Showed non-physiological factor that increased likelihood of relapse. That would be pretty hard, to tell a parent that they are contributing to the child's illness. Low EE (13%) No Drug Therapy Drug Therapy High EE (51%) < More than 35 hours Contact > Less than 35 hours Contact < 35 hours Contact, no drug therapy < 35 hours Contact, drug therapy > 35 hours contact, no drug therapy > 35 hours contact, drug therapy

15% 12% 20% 69% 42% 15% 92% 53%

Depression -- feelings of worthlessness, desperation, guilt and general misery Twice as frequently diagnosed in women vs. men

Drug therapies: o Tricyclic antidepressants o monoamine oxidase (MAO) inhibitors o atypical antidepressants o newer generation selective serotonin reuptake inhibitor (SSRI) drugs and SNRI drugs (also norepenephrin)

Can a disturbance in neurochemistry of brain be a cause of depression? Might there be environmental/social stressors that contribute to the onset of depression? Classic drug therapies: -- tricyclic antidepressants -- monoamine oxidase (MAO) inhibitors -- atypical antidepressants These three types of drugs have different mechanisms of action but they have a common consequence, namely? -- newer generation selective serotonin reuptake inhibitor (SSRI) drugs This type of drug inhibits reuptake of serotonin with the consequence of increased serotonin in synapses. What do neuro-imaging studies in humans reveal about brain processes in depression?