Chapter 15: Psychological Disorders

Looking at problematic behaviors that interfere with life.

2. Substance

Substance
AbuseAbuse
Definition:Definition:
Maladaptive pattern of substance use leading to clinically significant Maladaptive pattern of substance use leading to clinically significant
impairment of distressimpairment of distress
•Synapses, Reinforcement, & Drug UseSynapses, Reinforcement, & Drug Use
Experiments showed dopamine release in the area of the nucleus Experiments showed dopamine release in the area of the nucleus
accumbens was reinforcingaccumbens was reinforcing
Most abused drugs & ordinary pleasures lead to increased dopamine Most abused drugs & ordinary pleasures lead to increased dopamine
activityactivity
Recent research has dopamine & nucleus accumbens playing role in Recent research has dopamine & nucleus accumbens playing role in
attention-getting or arousal rather than pleasureattention-getting or arousal rather than pleasure

3. Common Drugs & Their Synaptic Common Drugs & Their Synaptic
EffectsEffects
StimulantsStimulants
Produce excitement, alertness, Produce excitement, alertness,
elevated mood, decreased fatigue, elevated mood, decreased fatigue,
& sometimes motor activity& sometimes motor activity
Highly addictiveHighly addictive
•AmphetaminesAmphetamines
Increases dopamine release from Increases dopamine release from
presynaptic terminals by reversing presynaptic terminals by reversing
the direction of dopamine transferthe direction of dopamine transfer
•CocaineCocaine
Blocks the reuptake of catechola-Blocks the reuptake of catechola-
mines & serotonin at the synapsemines & serotonin at the synapse
Behavioral effects are believed to Behavioral effects are believed to
be mediated primarily by dopamine be mediated primarily by dopamine
& secondarily by serotonin& secondarily by serotonin

4. Common Drugs & Their Synaptic Common Drugs & Their Synaptic
EffectsEffects
Effects of Effects of
Amphetamine & Amphetamine &
CocaineCocaine
Short-lived because of the depletion of Short-lived because of the depletion of
dopamine stores & tolerancedopamine stores & tolerance
•MethylphenidateMethylphenidate
RitalinRitalin
Prescribed for ADHDPrescribed for ADHD
Works like cocaine by blocking reuptake of Works like cocaine by blocking reuptake of
dopamine at presynaptic terminalsdopamine at presynaptic terminals
Repeated use of stimulants can have Repeated use of stimulants can have
permanent effects on brain functioningpermanent effects on brain functioning

5. Common Drugs & Their Synaptic Common Drugs & Their Synaptic
EffectsEffects
Nic o tineNic o tine
Stimulates the nicotinic receptor (a Stimulates the nicotinic receptor (a
type of acetylcholine receptor) in the type of acetylcholine receptor) in the
CNS & neuromuscular junction of CNS & neuromuscular junction of
skeletal musclesskeletal muscles
Also increased dopamine release by Also increased dopamine release by
attaching to neurons that release attaching to neurons that release
dopamine in the nucleus accumbensdopamine in the nucleus accumbens
The nicotine in tobacco is The nicotine in tobacco is 4 ½ times4 ½ times
more addicting than heroinmore addicting than heroin

6. Common Drugs & Their Synaptic Common Drugs & Their Synaptic
EffectsEffects
Opiate DrugsOpiate Drugs
Morphine, heroin & methadoneMorphine, heroin & methadone
The net effect is of increasing the The net effect is of increasing the
release of dopamine by stimulating release of dopamine by stimulating
endorphin receptorsendorphin receptors
They decrease the activity in the locus They decrease the activity in the locus
coeruleus resulting in a decreased coeruleus resulting in a decreased
response to stress & decreased response to stress & decreased
memory storagememory storage

7. Common Drugs & Their Synaptic Common Drugs & Their Synaptic
EffectsEffects
MarijuanaMarijuana
Contains Contains 
99
-THC which works by -THC which works by
attaching to canabinoid receptorsattaching to canabinoid receptors
•Hallucinogenic DrugsHallucinogenic Drugs
Drugs that distort perceptionDrugs that distort perception
Many hallucinogenic drugs Many hallucinogenic drugs
resemble serotonin & bind to resemble serotonin & bind to
serotonin type 2A receptorsserotonin type 2A receptors

8. Alcohol & AlcoholismAlcohol & Alcoholism
Alcoholism & Alcoholism &
Alcohol Alcohol
DependenceDependence
A common type of substance abuse A common type of substance abuse
that produces significant harm to the that produces significant harm to the
lives of others & the drinkerlives of others & the drinker
Alcohol inhibits the NaAlcohol inhibits the Na
++
ion flow across ion flow across
the neuron membranethe neuron membrane
It decreases serotonin activity, It decreases serotonin activity,
facilitates the transmission of GABAfacilitates the transmission of GABA
AA
receptor & blocks glutamate receptors receptor & blocks glutamate receptors
& increases dopamine activity& increases dopamine activity
Types of Types of
AlcoholismAlcoholism
Type I alcoholism: Type I alcoholism: less dependent on less dependent on
genetic factors, develops gradually genetic factors, develops gradually
over years, affects men & women over years, affects men & women
equally & is less severeequally & is less severe
Type II alcoholism: Type II alcoholism: has a strong has a strong
genetic basis, is rapid & has an early genetic basis, is rapid & has an early
onset, primarily affects men, is more onset, primarily affects men, is more
severe & is associated with criminalitysevere & is associated with criminality

9. Alcohol & AlcoholismAlcohol & Alcoholism
Risk Factors for Risk Factors for
Alcohol AbuseAlcohol Abuse
1. Less than average intoxication after 1. Less than average intoxication after
drinking a small to moderate amount of drinking a small to moderate amount of
alcoholalcohol
2. Experiencing more than average 2. Experiencing more than average
relief from tension after drinking relief from tension after drinking
alcoholalcohol
3. Having a smaller than normal 3. Having a smaller than normal
amygdala in the right hemisphereamygdala in the right hemisphere
2. Alcohol
High
(Stimulating
Opioid
Receptors)
4. Motivated to
Consume More
Alcohol
(Increased craving &
Loss of Control)
1. Alcohol
Consumption
3. Alcohol High
Diminishes
(Desire to stimulate
The Opioid
Receptors)

10. Major Major
DepressionDepression
Characteristics:Characteristics:
Feeling sad, helpless, lacking Feeling sad, helpless, lacking
energy & pleasure for weeks at energy & pleasure for weeks at
a time, feelings of worthlessness, a time, feelings of worthlessness,
trouble sleeping, can’t trouble sleeping, can’t
concentrate, little pleasure from concentrate, little pleasure from
food or sex, contemplating food or sex, contemplating
suicide & can’t imagine being suicide & can’t imagine being
happyhappy

11. Major DepressionMajor Depression
More
Shortness
Of Breath
Increased
Anxiety
Less
Energy
Tiredness
More
Shortness
Of Breath
Muscle
Tension
Shallow
Breathing
Anxiety
Deprsssion

12. Major DepressionMajor Depression

EvidenceofGeneticorOtherPrior

EvidenceofGeneticorOtherPrior
PredispositionsPredispositions
If there were relatives with depression that manifests before the age of 30If there were relatives with depression that manifests before the age of 30
It tends to be episodic & there were incoming feelings of depressionIt tends to be episodic & there were incoming feelings of depression
May have normal feelings for weeks, months or years between episodesMay have normal feelings for weeks, months or years between episodes
It is more common among women than men but equally common among It is more common among women than men but equally common among
childrenchildren
Most experiencing depression have decreased activity in the left hemisphere Most experiencing depression have decreased activity in the left hemisphere
& increased activity in the right prefrontal cortex& increased activity in the right prefrontal cortex

13. Major DepressionMajor Depression
Borna DiseaseBorna Disease
A viral infection of the nervous A viral infection of the nervous
system leading to periods of system leading to periods of
frantic activity alternating with frantic activity alternating with
periods of inactivityperiods of inactivity
In 1990 study, 30% of severely In 1990 study, 30% of severely
depressed persons tested positive depressed persons tested positive
for the Borna virusfor the Borna virus
•HypoglycemiaHypoglycemia
Causes: too little food, too much Causes: too little food, too much
insulin or diabetes or diabetes insulin or diabetes or diabetes
medication, or extra activitymedication, or extra activity
A sudden onset may progress to A sudden onset may progress to
insulin shockinsulin shock

14. Treatment for DepressionTreatment for Depression
Tricyclics
Prevent the presynaptic neuron from
reuptake of catecholimes or serotonin
•MOA Inhibitors
Block the enzyme monamine oxydase from
metabolizing catecholamines & serotonin into
active forms
•SSRIs
Similar to tricyclics but are specific to
serotonin
•Atypical Antidepressants
A miscellaneous group of drugs with
antidepressant actions & mild side effects;
they inhibit reuptake of dopamine & to some
extent norepinephrine

15. Treatment for DepressionTreatment for Depression

CognitiveTherapy

CognitiveTherapy
Produces effects similar to drugs Produces effects similar to drugs
for many depressed peoplefor many depressed people
Recovered are less likely to Recovered are less likely to
relapserelapse
•
Electroconvulsive

Electroconvulsive
TherapyTherapy
Inducing seizures with an electric Inducing seizures with an electric
shock to the headshock to the head
Application: every other day for Application: every other day for
about 2 weeksabout 2 weeks
About ½ will relapse within 6 mos.About ½ will relapse within 6 mos.
Most depressed people will enter Most depressed people will enter
REM sleep within 45 mins. of going REM sleep within 45 mins. of going
to bedto bed
Thoughts
EmotionsBehavior

16. Bipolar DisorderBipolar Disorder
Manic-Depressive Manic-Depressive
DisorderDisorder
Alternates between depression & Alternates between depression &
maniamania
2 types of bipolar disorder:2 types of bipolar disorder:
Bipolar I disorder:Bipolar I disorder: Has full- Has full-
blown episodes of maniablown episodes of mania
Bipolar II disorder: Bipolar II disorder: His milder His milder
phases of mania (hypomania)phases of mania (hypomania)
CharacteristicsCharacteristics
Mean onset is in the late 20sMean onset is in the late 20s
Brain activity is higher than Brain activity is higher than
normal during mania & lower normal during mania & lower
than normal during depressionthan normal during depression
There is a strong hereditary basis There is a strong hereditary basis
but there is no specific genebut there is no specific gene
Lithium salts are the most Lithium salts are the most
effective therapy but it isn’t effective therapy but it isn’t
known how they workknown how they work
Drugs used include valproic acid Drugs used include valproic acid
and carbamazepineand carbamazepine

17. Seasonal Affective DisorderSeasonal Affective Disorder
Usually in the Usually in the
WinterWinter
Most common in regions Most common in regions
closest to the poles where the closest to the poles where the
nights are very long and nights are very long and
there’s a very short summerthere’s a very short summer
Treatment is with bright lights Treatment is with bright lights
in either the morning or in either the morning or
evening for about 1 hourevening for about 1 hour

18. SchizophreniaSchizophrenia
CharacteristicsCharacteristics
Deteriorating ability to function in Deteriorating ability to function in
everyday life, delusions, hallucinations, everyday life, delusions, hallucinations,
movement disorders, thought disorders, movement disorders, thought disorders,
& inappropriate emotional expression& inappropriate emotional expression
•Behavioral SymptomsBehavioral Symptoms
Positive Symptoms:Positive Symptoms: (behaviors that (behaviors that
should be absent) delusions, should be absent) delusions,
hallucinations, inappropriate emotional hallucinations, inappropriate emotional
responding, bizarre behavior, & responding, bizarre behavior, &
thought disordersthought disorders
Negative Symptoms:Negative Symptoms: (missing behaviors (missing behaviors
that should be there) deficits in social that should be there) deficits in social
interaction & emotional expressioninteraction & emotional expression
Can be either acute or chronicCan be either acute or chronic

19. SchizophreniaSchizophrenia
DiagnosingDiagnosing
Difficult to diagnoseDifficult to diagnose
Conditions with similar Conditions with similar
symptoms:symptoms:
1. mood disorder with 1. mood disorder with
psychotic featurespsychotic features
2. substance abuse2. substance abuse
3. brain damage3. brain damage
4. undetected hearing loss4. undetected hearing loss
5. Huntington’s disease5. Huntington’s disease
6. nutritional abnormalities6. nutritional abnormalities
Demographic DataDemographic Data
Occurs in all ethnic groups & is Occurs in all ethnic groups & is
about equal in men & womenabout equal in men & women
It tends to develop earlier in It tends to develop earlier in
menmen
Expressed emotions: hostile Expressed emotions: hostile
expressions by a caretaker can expressions by a caretaker can
aggravate the conditionsaggravate the conditions
May be the reason for May be the reason for
increased number of cases in increased number of cases in
the U.S. & Europe compared the U.S. & Europe compared
to 3to 3
rdrd
world countries world countries
The older the father at the The older the father at the
time of birth, the greater the time of birth, the greater the
riskrisk

20. SchizophreniaSchizophrenia
GeneticsGenetics
There is a 50% concordance for There is a 50% concordance for
schizophrenia for monozygotic twins & schizophrenia for monozygotic twins &
a 15% concordance for dizygotic twinsa 15% concordance for dizygotic twins
This does not mean that schizophrenia This does not mean that schizophrenia
has a purely genetic causehas a purely genetic cause
There are no reliable markers for There are no reliable markers for
schizophreniaschizophrenia

21. Schizophrenia Schizophrenia
HypothesesHypotheses
Neurodevelopmental Neurodevelopmental
HypothesisHypothesis
Caused in large part by Caused in large part by
abnormalities to the nervous abnormalities to the nervous
system during the prenatal or system during the prenatal or
neonatal periodneonatal period
Many schizophrenics had problems Many schizophrenics had problems
before or shortly after birth that before or shortly after birth that
could have affected brain could have affected brain
developmentdevelopment
Rh incompatibility between mother Rh incompatibility between mother
& offspring is associated with & offspring is associated with
increased probability of increased probability of
schizophreniaschizophrenia
Season-of-birth effect: tendency Season-of-birth effect: tendency
for those born in winter months to for those born in winter months to
have a slightly greater probability have a slightly greater probability
of schizophreniaof schizophrenia
Mild Brain AbnormalitiesMild Brain Abnormalities
Many schizophrenics have slightly Many schizophrenics have slightly
smaller prefrontal cortex, smaller prefrontal cortex,
temporal cortex, hippocampus & temporal cortex, hippocampus &
amygdalaamygdala
Have smaller than normal cell Have smaller than normal cell
bodies & some neurons fail to bodies & some neurons fail to
arrange themselves in a neat, arrange themselves in a neat,
orderly mannerorderly manner
Have slightly larger right Have slightly larger right
hemisphere & lower than normal hemisphere & lower than normal
activity in the left hemisphereactivity in the left hemisphere
It appears late if the damage is It appears late if the damage is
done early because the damage is done early because the damage is
in areas that mature slowly in areas that mature slowly
producing minor symptoms in producing minor symptoms in
childhood, but impairments childhood, but impairments
increase with maturationincrease with maturation

22. Schizophrenia Schizophrenia
HypothesesHypotheses
Dopamine HypothesisDopamine Hypothesis
Schizophrenia is the result of excess Schizophrenia is the result of excess
activity at certain dopamine synapsesactivity at certain dopamine synapses
Evidence comes from drugs that relieve Evidence comes from drugs that relieve
the symptoms work on dopaminethe symptoms work on dopamine
Chlorpromazine:Chlorpromazine: Thorazine was the 1 Thorazine was the 1
stst

drug used successfullydrug used successfully
Antipsychotic drugs:Antipsychotic drugs: Block dopamine Block dopamine
receptorsreceptors
Phenothaizines:Phenothaizines:neuroleptic drugs neuroleptic drugs
including chlorpromazineincluding chlorpromazine
Butyrophenones: Butyrophenones: neuroleptic drugs neuroleptic drugs
including haloperidol (Haldol)including haloperidol (Haldol)
Substance-induced Substance-induced
Psychotic DisorderPsychotic Disorder
Characterized by hallucinations & Characterized by hallucinations &
delusions caused by drugs such as delusions caused by drugs such as
cocaine, amphetamine, MDMA & LSD cocaine, amphetamine, MDMA & LSD
that increase the activity of dopamine that increase the activity of dopamine
synapsessynapses
Stress increased the symptoms & causes Stress increased the symptoms & causes
release of dopamine from the prefrontal release of dopamine from the prefrontal
cortexcortex
Excess dopamine is not the only causeExcess dopamine is not the only cause
Drugs that block dopamine do so almost Drugs that block dopamine do so almost
immediately but behavioral effects over immediately but behavioral effects over
2 or 3 weeks2 or 3 weeks
Recent studies show schizophrenics Recent studies show schizophrenics
have2 X as many Dhave2 X as many D
22 as normals as normals

23. Schizophrenia Schizophrenia
HypothesesHypotheses
Glutamate Glutamate
HypothesisHypothesis
Schizophrenia is the result of Schizophrenia is the result of
deficient activity at certain deficient activity at certain
glutamate synapsesglutamate synapses
The brain releases lower than The brain releases lower than
normal amounts of glutamate in the normal amounts of glutamate in the
prefrontal cortex & hippocampus & prefrontal cortex & hippocampus &
has fewer glutamate receptorshas fewer glutamate receptors
Phencyclidine (PCP):Phencyclidine (PCP): blocks blocks
glutamate type NDMA receptors & glutamate type NDMA receptors &
produces a type of psychosis produces a type of psychosis
similar to schizophreniasimilar to schizophrenia
No drugs that treat schizophrenia No drugs that treat schizophrenia
directly stimulate glutamate directly stimulate glutamate
activityactivity

24. The Search for Improved DrugsThe Search for Improved Drugs

The

The
Me s o limbo c o rMe s o limbo c o r

tic a l S ys te m

tic a l S ys te m
A set of neurons that project from the
midbrain tegmentum to the limbic system
Believed to be the area where antipsychotic
drugs have beneficial effects
•
Ta rdive

Ta rdive
Dys kine s iaDys kine s ia
Characterized by tremors & other
involuntary movements
Probably due to denervation sensitivity
caused by prolonged blockade of dopamine
receptors

Atypic a l

Atypic a l

Antips yc ho tic

Antips yc ho tic
Drug sDrug s
New drugs that alleviate the symptoms of
schizophrenia while seldom producing
movement problems
They have less effect on D
2 & stronger effect
on D
4 & serotonin 5-HT receptors
Alleviate both positive & negative
symptoms of schizophrenia
The side effects include increased risk of
diabetes & impairment of the immune
system