Mania,depression and Schizophrenia

Pathophysiology of Mania,depression and Schizophrenia

1. Mental Illness
Mental Illness
Depression, Mania and
Depression, Mania and
Schizophrenia
Schizophrenia
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 the
It is when someone lacks the
ability to manage day to day
ability to manage day to day
events and/or control their
events and/or control their
behavior so that basic physical
behavior so that basic physical
and emotional needs are unmet.
and emotional needs are unmet.

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

4. What is mental illness
What is mental illness
like?
like?


Mental illness is a
Mental illness is a
physical condition just
physical condition just
like asthma or arthritis.
like asthma or arthritis.
But still society believes
But still society believes
that a person who is
that a person who is
mentally ill needs to
mentally ill needs to
show more willpower -
show more willpower -
to be able to pull
to be able to pull
themselves out it.
themselves out it.

5. …
…
..
..
It is also like
It is also like
telling a person
telling a person
who has an
who has an
amputated leg
amputated leg
to run across the
to run across the
room.
room.
But a person who has mental health
But a person who has mental health
issue has a
issue has a
“
“
broken brain
broken brain
”
”
.
.

6. Mental Illnesses
Mental Illnesses
in our Community
in our Community
Depression
Depression
Mania
Mania
Schizophrenia
Schizophrenia

7. Depression
Depression

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

9. Signs and Symptoms of
Signs and Symptoms of
Depression
Depression
§
§
Persistent sad, anxious
Persistent sad, anxious
or empty mood
or empty mood
§
§
Sleeping too much or
Sleeping too much or
too little; odd time of
too little; odd time of
waking
waking
§
§
Reduced or increased
Reduced or increased
appetite which results
appetite which results
in weight gain or loss.
in weight gain or loss.
§
§
Irritability or
Irritability or
restlessness
restlessness
§
§
Fatigue or loss of
Fatigue or loss of
energy
energy
§
§
Thoughts of death or
Thoughts of death or
suicide, including
suicide, including
suicide attempts
suicide attempts
§
§
Feeling guilty,
Feeling guilty,
hopeless or worthless
hopeless or worthless
§
§
Difficulty in
Difficulty in
concentrating,
concentrating,
remembering or
remembering or
making decisions
making decisions

10. What factors causes
What factors causes
depression?
depression?
There is no single cause of depression.
There is no single cause of depression.
But here are some factors that may
But here are some factors that may
contribute to it
contribute to it
’
’
s development:
s development:
§
§
Psychological
Psychological
§
§
Biological
Biological
§
§
Environment
Environment

11. Evidence also suggests.
Evidence also suggests.
Scientists have also found evidence which makes some
Scientists have also found evidence which makes some
people with a
people with a
genetic predisposition
genetic predisposition
to major
to major
depression vulnerable to the disorder. However not
depression 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 one
Death of a loved one
§
§
Major loss or change
Major loss or change
§
§
Chronic stress
Chronic stress
§
§
Alcohol and drug abuse
Alcohol and drug abuse
§
§
Heart disease and cancer
Heart disease and cancer
§
§
medications
medications

12. How does depression
How does depression
work?
work?
The way we respond to situations (with
The way we respond to situations (with
thoughts of hopelessness, anxiety, anger,
thoughts of hopelessness, anxiety, anger,
etc.) effects the emotions we feel, which
etc.) effects the emotions we feel, which
in turn, effects the chemicals that are
in turn, effects the chemicals that are
released within our body.
released within our body.
And all emotional responses have a
And all emotional responses have a
chemical consequence.
chemical consequence.
Serotonin
Serotonin
, a
, a
neurotransmitter (body chemical), is a
neurotransmitter (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. Serotonin
Serotonin
When a person is depressed, their
When a person is depressed, their
serotonin level is low, which causes
serotonin level is low, which causes
several changes to the body:
several changes to the body:
1.
1.
Pain Threshold Lowered
Pain Threshold Lowered
:
:
A depressed person
A 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 Disturbance
Sleep Disturbance
:
:
there are many spikes in
there are many spikes in
temperature throughout the night which causes
temperature throughout the night which causes
a person to wake many times, resulting in not
a person to wake many times, resulting in not
getting any REM sleep.
getting any REM sleep.

16. The Cycle of Depression
The Cycle of Depression

17. Treatment of Depression
Treatment of Depression
Be sensitive to their feelings, and validate
Be sensitive to their feelings, and validate
those feelings.
those feelings.
Teach emotion-coping skills
Teach emotion-coping skills
:
:
§
§
Acknowledge and express emotions.
Acknowledge and express emotions.
§
§
Remind the person to challenge irrational thoughts and
Remind 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 to
Teach that for every one negative thought they need to
think of two positive thoughts.
think of two positive thoughts.
Teach problem-solving skill
Teach problem-solving skill
:
:
§
§
Help determine importance of problem while keeping
Help determine importance of problem while keeping
down their stress and anxiety
down their stress and anxiety
§
§
Break problem into small chunks
Break problem into small chunks
§
§
Remind the person that it is ok to ask for help
Remind 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. Mania
Mania
(bipolar
(bipolar
disorder)
disorder)

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

21. Signs and Symptoms of
Signs and Symptoms of
Mania
Mania
§
§
Increased physical and
Increased physical and
mental activity &
mental activity &
energy
energy
§
§
Excessive irritability,
Excessive irritability,
aggressive behavior
aggressive behavior
§
§
Decreased need for
Decreased need for
sleep; without
sleep; without
experiencing fatigue
experiencing fatigue
§
§
Exaggerated optimism
Exaggerated optimism
and self-confidence
and self-confidence
§
§
Racing speech and
Racing speech and
thoughts; flight of
thoughts; flight of
ideas
ideas
§
§
poor judgment
poor 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 studied
have been studied
since the 1960s as factors in mania and
since the 1960s as factors in mania and
depression.
depression.
§
§
For example,
For example,
during a manic episode, clients with
during a manic episode, clients with
bipolar disorder have a significantly higher
bipolar disorder have a significantly higher
Norepinephrine and epinephrine
Norepinephrine and epinephrine
levels than a
levels than a
depressed or euthymic (normal mood) person.
depressed or euthymic (normal mood) person.
§
§
Norepinephrine and epinephrine are responsible
Norepinephrine and epinephrine are responsible
for
for
“
“
fight or flight
fight or flight
”
”
responses.
responses.
T

23. Treatments
Treatments
§
§
Those with bipolar disorder cannot depend on
Those with bipolar disorder cannot depend on
medication alone as a treatment.
medication alone as a treatment.
§
§
The
The
antidepressants
antidepressants
on their own can cause rapid
on their own can cause rapid
mood changes which can make manic episodes
mood changes which can make manic episodes
worse.
worse.
§
§
Lifestyle changes and social support
Lifestyle changes and social support
will help
will help
someone suffering from bipolar live a normal life
someone suffering from bipolar live a normal life
including enjoying a successful career and
including enjoying a successful career and
relationships.
relationships.

24. Schizophrenia
Schizophrenia

25. What is Schizophrenia?
What is Schizophrenia?
Schizophrenia is a chronic and severe brain
Schizophrenia is a chronic and severe brain
disorder.
disorder.


It is a disease that makes it difficult for a person to
It is a disease that makes it difficult for a person to
tell the difference
tell the difference
between real and unreal
between real and unreal
experiences,
experiences,
to think logically, to have appropriate
to think logically, to have appropriate
emotional responses to others, aspects of memory
emotional 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) has
The World Health Organization (WHO) has
identified schizophrenia as
identified schizophrenia as
one of the ten most
one of the ten most
debilitating diseases
debilitating diseases
affecting all human beings.
affecting all human beings.

26. Symptoms of
Symptoms of
Schizophrenia
Schizophrenia
The severity of
The severity of
symptoms varies
symptoms varies
from one person to
from one person to
another, and
another, and
typically symptoms
typically symptoms
will decline and
will decline and
then reappear.
then reappear.
Symptoms are
Symptoms are
divided into
divided into
Positive
Positive
and
and
Negative
Negative


symptoms.
symptoms.

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

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

29. What Causes
What Causes
Schizophrenia?
Schizophrenia?
There is no one cause to this
There is no one cause to this
complex and puzzling illness,
complex and puzzling illness,
but it is believed that some
but it is believed that some
combination of genetic,
combination of genetic,
biological (virus, bacteria, or an
biological (virus, bacteria, or an
infection) and environmental
infection) and environmental
factors
factors
play a major role.
play a major role.
There is currently no reliable
There is currently no reliable
way to predict whether a
way 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 of
What Occurs in the Brain of
Someone with Schizophrenia?
Someone with Schizophrenia?
Researchers believe an
Researchers believe an
imbalance of
imbalance of
neurotransmitters
neurotransmitters
may cause the
may cause the
symptoms of schizophrenia. Two
symptoms of schizophrenia. Two
neurotransmitters that have most been
neurotransmitters that have most been
implicated as abnormal in schizophrenia
implicated as abnormal in schizophrenia
are
are
dopamine and serotonin.
dopamine and serotonin.


The
The
ability to produce images
ability to produce images
have helped
have helped
in identifying structural and functional
in identifying structural and functional
differences in a schizophrenic brain versus
differences in a schizophrenic brain versus
a normal brain.
a normal brain.

31. From The Looks of It
From The Looks of It
Brian imaging has shown a difference in:
Brian imaging has shown a difference in:
§
§
Enlargement of the ventricle
Enlargement of the ventricle
§
§
Decrease in the hippocampus
Decrease in the hippocampus
(controls emotional and
(controls emotional and
working memory)
working memory)
§
§
Decrease in overall size
Decrease in overall size
§
§
Abnormal development of pre-frontal cortex
Abnormal 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 Schizophrenia
Treatment of Schizophrenia
§
§
The acute psychotic schizophrenic patients will
The acute psychotic schizophrenic patients will
respond usually to
respond usually to
antipsychotic medication.
antipsychotic medication.
§
§
According to current consensus we use in the first
According to current consensus we use in the first
line therapy the
line therapy the
newer atypical antipsychotics,
newer atypical antipsychotics,


because their use is not complicated by appearance
because their use is not complicated by appearance
of extrapyramidal side-effects, or these are much
of 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. Treatment
Treatment
With all three of these
With all three of these
illnesses, treatment, with
illnesses, treatment, with
the right combination of
the right combination of
medications and/or
medications and/or
therapy, can help stabilize
therapy, can help stabilize
the moods that
the moods that
interfere with
interfere with
a productive
a productive
life.
life.

34. THANK YOU