2008-04-03

Hypochondriacs actually feel and exhibit the symptoms of whatever, but there's no medical cause. Conversion disorder is somewhat the same thing, where emotional pain becomes physical pain. It's a way of 'deflecting' and it's kind of synesthetic. So you get to create this for yourself. Nice thing about conversion disorder is that once the person works through whatever thing it is, the pain and dysfunction will go away. Conversion disorder has a good prognosis. There are common places on the body for conversion disorder to show up: arm band, waist band, wrist band, knee band, ankle band, thigh band, glove, swim trunks, chest band, neck band, head band. Depression is so common is that some people think that we have an epidemic. And they call us the Prozac nation because we over-subscribe antidepressants, and depression seems to be a disease of the western cultures.

Unipolar affective disorder is depression. You can have bipolar disorder, and seasonal affective disorders. There's an element of depression within these mood disorders. For depression to be considered major or clinical, it has to be three months or longer. Under three months of depression is more transient and it's life, and you have a situation that you are dealing with. Once it exceeds three months, it is really biochemical, and there's some things that let doctors know it's depression: sighing a lot (trying to slow down the autonomic response). That's a major sign. Pacing and the ringing of the hands, this kind of stuff, all the time, that's an indication, and most of this has to do with your social life. People with major depression will stop seeing friends, will stop dating, so when they withdraw and start to let their social life go, that's major depression. Intervention is almost useless ("let's go do something fun!"). They really just can't mentally get there. Martin Seligman suggested that depression might be cognitive and thought-processes, from helplessness to hopefulness, once you have decided that your future is black and you really and truly believe that, you get into a cycle that keeps you trapped here and it's called "learned helplessness". But what the neurochem-basis of cognition? This is exemplified by pessimistic explanatory style. You can't know which comes first (cognitive part or biochem part). Once you're in the cycle, it's highly unlikely, although short term cycles can be cognitively fixed perhaps. This is not a lifetime diagnosis. Susceptibility to depression can be genetic. So as for the hopelessness theory - hopelessness is the "final pathway" (still cognitive model): pessimistic explanatory style plus high stress plus, low self-esteem plus, etc. What about the neurochemical changes in a depressed brain? If you are sad for a long enough time, this might give you major depression. So is it chem->cog or is it cog->chem or both or what's going on? What if your brain is going "off track" every once in a while and enhances depression and it gets wildly out of control? This can be tested, if we can isolate depressional circuits. Seligman was on target re: the cognitive process of depression, rewriting the mental outlook, it really helps. If you can do both, you can do well. If you know somebody who is depressed, if they say that the meds don't help, are they getting the cognitive part? Placebo stuff needs to help.

The more poor your social skills, the more likely you are to be depressed. Reinforcers like friends, social rewards, jobs, etc., keep some people out of depression. There is a social component to depression. What about people that work better when alone? Isolation can trigger depression, even if they prefer to be alone. Negative thinking predicts depression. If you have a family trend of depression, you should probably watch your own mood swings. Puckett's family does bipolar+depression (yikes). Bad moods are part of life, clinical depression can kill you. It affects 1/20 Americans a year. Signs: don't feel hopeful or happy about anything, slow motion, nothing tastes good, getting up requires great effort. Depression itself, even if you don't get depressed enough to commit suicide, you change your physiology, and people who change their physiology tend to not live as long.

Bipolar (manic depression -- but really it's bipolar affective disorder). Depression is unipolar. This is bipolar: you go from extremes of extreme high to extreme low. Unipolar is just low. We can tell from people's history whether or not they are bipolar. Teddy Roosevelt was bipolar, Abraham Lincoln was depressed. Suicide is one of the indicators. The prognosis: during a mania, being too stupid to stay alive. Manias are just as dangerous as depressions. Mania-people will die of alcohol poisoning during partying. We have not seen people who have just had manias and never get depressed -- this would be like taking drugs. People in the manias *are* like people on drugs. They are experiencing highs and rushes and so on, they feel fabulous and they feel the best they have in their entire lives, so why take the drugs? Their judgement is not exactly clear. Grandiosity is a symptom of mania ("I can fly"). Delusions of grandeur ("I'm the best at something"). Mania goes through three stages: hypomania, mania, severe mania. Mania can have an irritability stage. In bipolar-2 (Luisa, apparently; what about Linda?), they only have hypomanias and deep depressions. They just have the euphoric stages (really high, not much sleep), but then they just crash all the way down. Extreme mania can be as bad as schizophrenia. There are plateus in mania, those are months, not years. You are guaranteed a great depression after a very extreme mania. Major affective disorder. Cyclothyamine, etc. Then there's bipolar-1. The extremes of bipolar-2 mean dysfunctionality and maladaptiveness. Dysthymia, that's where instead of deep depressions, you don't have high manias, and you don't have deep depressions, so you are somewhat depressed and somewhat hyperactive. In unipolar, we know it's serotonin, and we raise it by inhibiting its takeup by nerves. We try to raise the bottom. With bipolar we want to deal with that, we give them Prozac or Welburtrine, if you give them just that you soar them into mania, and then give them lithium to bring them down. And then you give them a mood stabilizer to help keep the mood flat. And then sometimes they use six medications to keep the mood flat. You can take lithium to help the peaks, a mood stabilizer to even things out, antiepileptics to help the flips, and then something for insomnia, and something for the other things that all of the pills cause. Some of the side effects is the affective-side-effects, you don't feel and "feel dead". They "don't feel anything". They are not becoming hyperdelusional and not in the depressions. So it's more manageable. For example, when somebody dies in your family, in the "feeling retardation" -- if somebody in the family dies, you don't 'feel' anything.

Seasonal Affective Disorders -- of the summer and winter. Uh, why not just go to the other side of the planet?. This can be fixed. Severe SAD can be medically fixed. Summer hotness -- too hot -- can't do much. A summer house somewhere would be great. Mood disorders are, in fact, genetic. What is the relationship between mood disorders and personality disorders? If you have somebody that has a mood disorder, be aware of your own moods.

Schizophrenia - what does schizo mean? Schizism. It means split. Schizophrenia means split-mind. It does not mean split-personality. It means that you have made a split from reality. You don't have contact with reality. Uh? If we acknowledge its existence, then it's real. Schizophrenia has various subtypes. There are some things that are common: delusions, hallucinations, disorganized speech, deterioration of adaptive behavior, disturbance in society, etc. Disturbances in perception and thought can be bizarre, such as believing the color green is poisonous and you can't be in the same room with green, and it's a strong belief, period. It can be the hallucinations: you see and here things that aren't there. Nancy Andreasen came up with the idea of calling them positive/negative symptoms: positive symptoms include hallucinations, disorganized and deluded talk, inappropriate laughter/tears/rage. Negative symptoms include toneless voices, expressionless faces, mute. One of the problems with schizophrenia is that we have not found a cookie-cutter stamp of what it looks like to have schizophrenia. It comes on about age 15 to 17. They will exhibit the change very early as a teen, and since they are changing a lot anyway, it does not get detected until later. Speech disorders include word salad (random words that don't make sense except to the person), neologisms (words that you made up, or combined words), clang associations - connections between thoughts that are dictated by chance sounds of words rather than their meanings. "Ring-a-dang-ring-adang-ring-ring-a-dang". Hallucinations are generally auditory: so in A Beautiful Mind, for John Nash to see people -- well, that's uncommon. Visual hallucinations do not occur often. Delusions are beliefs that have little or no basis in reality and are elaborate ("I am Napolean, and I remember - history books are wrong"). Persecution delusions - people are conspiring against you. Influence delusions - people are controlling you (brain implants). Grandeur delusions. Paranoia delusions.

Etiology of schizophrenia - 48% of identical twins with schizophrenia shows a genetic correlation. Born to parents with schizophrenia? Then you have a 46% likelihood. We know it has something to do with dopamine, because it's hard to make dopamine, and we know how to prevent it to be picked up, and how to make it be picked up faster, and we have some drugs but they have intense side-effects like _______ when your nerves become rigid and tremor, that's a side-effect of the drug to help with schizophrenia. See http://schizophrenia.com. Episodes tend to be triggered by stress. And when it comes on in your life tends to have to do with stress. Neurodevelopmental hypothesis - having flu (influenza, not a cold bug) during pregnancy tends to lead to schizophrenia? Prenatal viral infection, prenatal malnutrition, obstetrical complications, other brain insults (shaken/fall-hit-head). Very early problems. Catotonic schizophrenia. Levels of dopamine. Viral infections or lack of nutrition as infants? In hospitals we give them food through tubes in catonic schizophrenia. Catatonia.

Types:
  1. Paranoid - delusions of persecution and grandeur, suspicious of friends and relative, that they have done something to hurt you, that they have paid an assasin to kill you, whatever, the level of paranoia is irrational and violent.
  2. Disorganized - disorganized speech or behavior (word salad), or flat or inappropriate emotion - emotional indifference, social withdraw. This is sometimes not radical and they are just called a jerk, and it's socially maladaptive.
  3. Catatonic - immobility, extreme negativisim, repeating of another speech or movements (sometimes autistic movements - repetitive speech and movements, might be misdiagnosed as autism). When they are hyperactive they are still incoherent.
  4. Undifferentiated - mixture of varied symptoms
  5. Residual - extreme withdrawal, which seems like a depression, after hallucinations and delusions have disappeared


Do they freeze in an attempt to preserve state? No memory of what goes on. They might report being aware of what's going on around them, but not clearly. We have hooked people in catatonia up, and they might be rapid fire like in a dream, or in a meditation level.