Analyzing

Analyzing Psychological Disorders

Areas of the brain affected

In the biology of schizophrenia there has been research that demonstrates  that the areas of the brain with abnormal structure are the hippocampus, amygdala, and thalamus with the temporal lobe and frontal lobes as relatively small (Comer, 2011). Further research has shown Broca’s area is a part of the brain that helps produce speech and that there is an excess flow of blood through this area when patient experiences auditory hallucinations (Comer, 2011). With the use of MRIs brain damage has been consistently seen in the temporal lobes. Post mortem research has shown widespread neuron loss and abnormalities of neuron structure and circuitry in various parts of a schizophrenic brain (Pinel, 2011). It has been found through brain scans that a person with schizophrenia may have an enlarge ventricles and that this may somehow be a sign that the parts of the brain may not have developed properly, and this may be the reason for abnormal flow of blood in certain areas of the brain.

Casual factors

It is known that only 1 percent of the world population ever develops schizophrenia with only a 10 percent chance of an adopted person developing schizophrenia. It is found that the chances increase greatly in identical twins (45%) than fraternal twins (10%) (Pinel, 2011). It has been found that if one twin is diagnosed with schizophrenia that it is likely that the other twin will have a 48 percent chance of developing the disorder.” This expectation has been documented consistently by research” (Comer, pg.379, 2011). Schizophrenia has multiple causes in which diverse genes have been linked to this disorder but it has yet been determined as to how these genes contribute to schizophrenia. There are other factors that may contribute to the development of schizophrenia for example early infections shortly after birth or complications during delivery of a child can alter the normal course of neurodevelopment in someone who might be suspect to a genetic link. It is believed by genetic researchers that schizophrenia is a biological predisposition and people develop schizophrenia later in life when they face an event that is stressful this can occur during adolescent or early adulthood. (Pinel, 2011).

Associated symptoms

The DSM-IV states the diagnosis for schizophrenia can only be given after the symptoms to this disorder have continued for a period of six months or more, and the person that is diagnosed for schizophrenia disorder must also show some sort of deterioration in their work, and social relations including the inability to care for themselves. Schizophrenia is difficult to diagnose because it shares some of the same symptoms associated with Parkinson disease and bipolar disorder, and may overlap with other psychiatric disorders. In order to better understand the symptoms of schizophrenia the DSM-IV has put a distinction of positive and negative symptoms referred to as type I and type II. Type I schizophrenia is said to be lead by positive symptoms such as delusions, hallucinations, inappropriate affect, incoherent speech or thought and odd behavior. Type II displays negative symptoms such as affective flattening- the absence or reduction of emotional expression, Algia- the reduction or absence of speech, Avolition- the reduction or absence of motivation, and Anhedonia- the inability to experience pleasure (Pinel, 2011). Only two of these symptoms is necessary in a one month time to be diagnose with schizophrenia and only symptom is needed if the symptom is a delusion or hallucination such as hearing voices.

Neural basis

Even with the over activity of dopamine at the D2 receptors its role in schizophrenia is limited because there other receptors that play a role in schizophrenia. Research from hallucinogenic drugs such as LSD and PCP have shown to produce similar symptoms of schizophrenia and this is done by acting on the serotonin and glutamate transmissions (Pinel, 2011). Clozapine is an atypical antipsychotic drug and even with its therapeutic-properties in the treatment of schizophrenia it has shown an attraction for D1 and D4 receptors along with several serotonin receptors, but not so much for D2 receptors. Even though clozapine is effective in treating schizophrenia without side effects that look like Parkinson disease there is a draw back because it does produce severe blood disorders in some patients. However with the use of other atypical neuroleptics it usually takes weeks to reduce the symptoms of schizophrenia. It appears that blocking D2 receptors triggers a slow evolving compensatory change in the brain which is a key factor in the therapeutic effect (Pinel, 2011). In treating schizophrenia with neuroleptics we find that the beneficial effects only act on some symptoms of schizophrenia more effectively the positive symptoms. However optimistic about the treatment with atypical neuroleptics they do produce their own diverse side effects such as diabetes, weight gain, and fat regulation problems. There is however a discontinued use rate of 74 percent for both atypical and typical neuroleptics (Pinel, 2011).

Appropriate Drug Therapies

It has been shown that by using conventional antipsychotic drugs can reduce symptoms of schizophrenia up to 65 percent in patients diagnosed with schizophrenia. Some of the newer atypical antipsychotic drugs are Clozapine, Risperdal, Zyprexa, Seroquel, Geodon and Abilify. These drugs are received more at D1, D4 and serotonin receptors and received less at dopamine D2 receptors. In fact, atypical antipsychotic drugs look to be more effective than conventional drugs, helping 85 percent of people diagnosed with schizophrenia (Pinel, 2011). In comparison to other treatments these drugs seem to be a more effective approach to treating schizophrenia than any one approach alone.

Case Study Beth, Anorexia

Anorexia is one of many eating disorders and is considered a mental disorder in which people simply are not eating. What interjects to the mental state of this disorder is low self-esteem, depression, perfectionism and feeling inadequate, and all can lead to the progression of an eating disorder. This disorder can be characterized by not eating at all and then broken up with by eating large amounts of food in a short period of time this is known as binge eating. Some of the health problems that anorexics suffer from and often require medical treatment for reduced metabolism such as bradycardia (slow heart rate), hypotension (low blood pressure), hypothermia (low body temperature), and anemia (deficiency of red blood cells) (Pinel, 2011). Studies show the gastrointestinal tract as our source of hunger and satiety. Peptide is a chemical that is released from the stomach through the gastrointestral system and interacts with neurotransmitters and hormones in the brain. The peptide in charge of increasing our hungriness is manufactured through the hypothalamus.

With the of hungriness and surfeit peptides has ignited a new awareness about the hypothalamus‘s role in hunger and satiety.  Studies have indicated that serontonin has a part in reduce hunger, eating, and body weight (Pinel, 2011).Anorexics like bulimics often see themselves as much larger and less attractive than they really are. In Beth case this is exactly how she sees herself. This type of thinking can often lead to depression or low self-esteem. Here again no matter how much weight she loses she still has a poor image of herslf. Anorexia can be linked to obsessive-compulsive disorder and depression this disorder does not do well with existing therapies and most short term improvements usually follow a relapse. What is known from a biological standpoint is there seems to be growing evidence that OCD and anorexia share common neurobiological pathways and from these studies  they show a dysfunctional orbitofrontal-subcortical circuits involved in OCD symptomatology which seems to be a key factor in anorexic symptoms(Conrad,  Wegener, Geiser, Imbierowicz, & Liedtke, 2008). There have been some clinical trials using atypical antipsychotic drugs to treat eating disorders (McKnight, & Park, 2010).

Nature or Nurture

Anorexia is something that is nurture because the idea that people should look a certain way is a message that is given through the media which some might say allows society to be nurtured by the media, thus causing some people to establish an eating disorder to meet that image. Such images that cannot be met can cause low self-esteem or feeling inadequate because of pressure to look a certain way. In Beth’s case she was normal to begin with but somehow she thought she had to lose weight because she was overweight. The nature side might say that if you family members with an eating disorder that you have a fair chance of developing the disorder yourself. Treatment for Beth I would recommend is a prescription of non-benzodiazepine hypnotic drug, sleep restriction bio feedback, muscle relaxation, and deep breathing exercises.

Case Study Mary, Insomnia

Insomnia is a sleep disorder which involves the initiating and maintaining sleep. Some of the common symptoms for insomnia are mood disorders and depression. Sometimes anxiety can be linked to the inability to sleep in which case these can be treated with counseling suggesting that they only go to sleep when they feel extremely tired (Pinel, 2011). In some case insomnia can be created through their doctors by prescribing medication that the patient becomes dependent on and cannot stop without feeling with drawl symptoms. Since Mary does not suffer from depression, drinks alcohol, or takes drugs of any kind I believe that Mary could be suffering from periodic limb disorder which is characterized by involuntary movements of the limbs which may include twitching of the legs and is considered a chronic sleep disorder (Pinel, 2011). Mary may not know that this is taking place as she sleeps. The area of the brain that promotes sleep is the anterior hypothalamus and the posterior hypothalamus promotes wakefulness (Pinel, 2011).  As for a treatment for Mary there are two classes of drugs for sleep hypnotic drugs which increase sleep and antihypnotic drugs reduce sleep. There is a third class of drugs that influences the circadian rhythmicity. Hypnotic drug benzodiazepines are very effective in treating chronic sleep disorders but there are some complications linked to their use.

  • The patient can develop a tolerance for benzodiazepine which would result in having to take larger doses to maintain its affect, thus resulting in addiction.
  • Termination of benzodiazepine after heavy use can result in insomnia.
  • Benzodiazepine can cause next day drowsiness
  • A disruption in sleep patterns with an increase in stage 2 sleep while decreasing stage 4 of REM sleep.

Melatonin is a hormone is produced from serotonin in the pineal gland. Researchers have argued that giving melatonin at night would increase sleep by speeding up the nocturnal phase of the circadian rhythm (Pinel, 2011). There have been improvements with melatonin use on insomnia patients with melatonin deficiencies.

Insomnia is related to both nature and nurture. People with a genetic predisposition are more likely to be insomniac, however, habits and other variables relate to nurture. My recommendation may be try to restore an adequate diet and using several psychological therapies such as cognitive behavioral and family therapy or a combination of both.

 

Reference

Conrad, R., Wegener, I., Geiser, F., Imbierowicz, K., & Liedtke, R. (2008). Nature against nurture: calcification in the right thalamus in a young man with anorexia nervosa and obsessive-compulsive personality disorder. CNS Spectrums, 13(10), 906-910.

Comer, R. J. (2011) Fundamentals of abnormal psychology (6th ed.). New York, NY: Worth

 

Pinel, J. P. J. (2011). Biopsychology (8th ed.). Boston.MA: Pearson

McKnight, R. F., & Park, R. J. (2010). Atypical antipsychotics and anorexia nervosa: A review. European Eating Disorders Review, 18(1), 10-21.

Conrad, R., Wegener, I., Geiser, F., Imbierowicz, K., & Liedtke, R. (2008). Nature against nurture: calcification in the right thalamus in a young man with anorexia nervosa and obsessive-compulsive personality disorder. CNS Spectrums, 13(10), 906-910.

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