Lecture # 208:
Mood Disorders and Schizophrenia

copyright Cheryl K. Hosken 2008


Mood disorders clearly demonstrate a disturbance in emotional reactions or feelings. Almost all psychological disorders have an impact on mood or affect, but the major symptom of these disorders is the intensity or extreme nature of the mood.

Types of Mood Disorders
Major Depression is the diagnosis for a group of symptoms that include feeling sad, hopeless, and despondent. There is also loss of interest in most normal activities. Associated with major depression are poor appetite, insomnia, loss if interest in sexual activity, loss of energy, and feelings of worthlessness.

This mood disorder is diagnosed twice as often in women as in men. During any six-month period, approximately 6.6% of women and 3.5% of men will have an episode of major depression. This ratio holds true across nationalities and ethnic groups. It is estimated that 100 million people in the world suffer from major depression. It is a fairly chronic condition with as many as 10% of depressed patients being continuously ill for 15 years or more.

Bipolar Disorder is a condition where there are episodes of depression and mania. Mania is characterized by an elevated mood with feelings of euphoria and irritability. In a manic state, one shows increased activity, talkativeness, and decreased need for sleep. Mania cannot be maintained for a long period of time because it is too tiring for the body and the mind. Mania is cyclical and relapse into the manic state occurs in 40% of people. It is rare that people have manic states without periods of depression.

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Dysthymia is a mild case of a major depression. The disorder is chronic, with recurrent pessimism, low energy level, and low self-worth. Whereas major depression tends to occur in a series of extremely debilitating episodes, dysthymia is more a continuous sense of being depressed and sad.

There is no identifiable event that causes the depressed mood of dysthymia. To feel overwhelmingly depressed when you hear of the death of a good friend is not the same type of depression as dysthymia. We all have periods of depression from time to time, but when we do, there is usually a reason for it. With major depression and dysthymia, there is a distressing debilitating mood that is present without reason.

Question:
1. What are the mood disorders and their symptoms?
(One or more of the following answers may be correct.)
Bipolar Disorder - episodes of depression and mania.
Dysthymia - recurrent pessimism, low energy level, and low self-worth.
Schizophrenia - a distortion of reality and a retreat from other people.
Major depression - feeling sad, hopeless, and despondent.


What causes depression? There are inter-related causes that are biological and psychological in nature.

Bipolar mood disorder is not common. The chances of developing bipolar disorder in the average population are .05%. If a brother, sister or parents have had the disorder, the chances of developing the disorder are 15%. If there are identical twins and one has the disorder, there is a 70% chance of the other twin also having the disorder. This means there is evidence that there may be a genetic predisposition to this disorder. With depression, the genetic percentages are not as high as for bipolar disorder. With twins, there is a 40% chance that if one twin has major depression, the other twin will also have the problem.

Even if we knew the specific gene that causes depression, we would be challenged to identify the mechanisms that cause the disorder in the mind. Certain neurotransmitters have been known to influence mood directly. They are called biogenic amines and include such neurotransmitters as serotonin, dopomine, and norepinephrine. One of the more helpful studies researchers found was that when the drug reserpine was given to patients to lower high blood pressure, there was increased depression in these patients. It was then discovered that reserpine lowered the brain's level of norepinephrine.

Question:
2. How is depression/mania treated in your country?


Theories for causes of depression - biological factors:
A. One theory for depression is that there is a shortage of biogenic amines, and that mania is caused by excess of these amines. However, we cannot determine why these biochemical imbalances occur in some people and not in others. Perhaps this is due to inherited genes.
B. The second theory is that stress causes changes in the amount of neurotransmitters in the brain. We know that stress causes and increase in the amines. Perhaps if the stress is prolonged, the supply of the amines is decreased leading to symptoms of depression. These two theories sound logical, but as yet, there is insufficient evidence to prove them.

In examining the brains of depressed persons, there are differences from the normal brain. Persons with mood disorders have abnormally large ventricles in the brain. Patients with bipolar disorder have high levels of white matter in the brain. Patients with depression have larger thalamuses than normal.

Theories for causes of depression - Psychological factors:
Learning theorists say that mood disorders are due to experiences. This includes a lack of reinforcers of behaviors. If a baby in an orphanage responds in various ways, but no one responds back to him, he responds less and less to the world about him and draws into himself and become depressed. He may even die.

Other theorists say that depression is a cognitive disorder. The argument is that for some reason, some people think of themselves as less worthy than others. They blame themselves for their failures and may believe that they are ineffective people. If the person looks at himself this way every day, he tends to increase his failures and self doubt. Such a cycle leads to depression.

Other views about the causes of depression have a psychoanalytic basis. It is thought that depression comes from early childhood experiences that lead to anger and this anger is directed inward. In brief we conclude that depression probably comes from a combination of genetic factors, biochemical factors, learning experiences, situational stress, and cognitive factors. Which of these is most important has not been determined.

Question:
3. What are some possible biological and psychological causes for mood disorders?
(One or more of the following answers may be correct.)
High levels of white matter or larger thalamuses in the brain.
Some people think of themselves as less worthy than others.
Personal sin, demon-possession, a curse on one's ancestors.
A shortage or an excess of biogenic amines in the brain.


Mood disorders are diagnosed in women twice as often as in men. There are several hypotheses for why this happens. The first is that women feel more open to discuss their feelings than do men. If they are more open to sharing their sad, unhappy moods, they may be diagnosed more often than men. In contrast, men are more likely to respond to feelings of depression by abusing alcohol. The second is that perhaps women are exposed to more stressors than men (less education, less good employment opportunities, lower wages, responsibilities of childrearing) that make them depressed. The final hypothesis is that men are more often psychiatrists and they simply diagnose the disorder more frequently in women.

Question:
4. These descriptions have not mentioned spiritual causes for depression. Have you met people you think are depressed for spiritual reasons? What is the mechanism involved?


Schizophrenia

Schizophrenia is a diagnosis for what may be several different disorders, which have in common a distortion of reality and a retreat from other people accompanied by disturbances in affect, behavior, and cognition. Schizophrenia can impair every aspect of living. The range of symptoms is so great that it is nearly impossible to specify which are fundamental and which are secondary.

Incidence and Types of Schizophrenia
Schizophrenia can be found all around the world at the same rate: about 1% of the population. People in developing nations have more acute (intense and short-lived) episodes and a better outcome of the disorder than people in industrialized countries. Schizophrenia occurs at the same rate in both sexes, but symptoms are more likely to appear earlier in males and males are more likely to be disabled by the disorder. In the U.S., schizophrenia treatment amounts to 75% of the money spent on mental health.

Question:
5. What are symptoms of schizophrenia?
(One or more of the following answers may be correct.)
Disturbances in affect, behavior, and cognition.
Early childhood experiences that lead to anger and this anger is directed inward.
A distortion of reality and a retreat from other people.


The prognosis for schizophrenia is not encouraging. About 25% recover fully from the first episode and do not have recurrences. In about 50% of all cases of schizophrenia, there is recurrent illness with periods of remission. In 25% of the cases there are no signs of recovery and there is long-term deterioration. Prognosis is related to when intervention begins. If treatment begins immediately, after the initial episode, the prognosis is fairly good - as good as 83%.

Schizophrenia is a label that applies to several disorders. In this way, the term schizophrenia is not unlike the term cancer. To say the term cancer communicates only a general diagnosis. We need to know what sort of cancer. Classifying different varieties of schizophrenia is a way to better understand the cause of the disorder that leads to more effective treatment.

Schizophrenia is described in negative symptoms and these are emotional and social withdrawal, reduced energy and motivation, apathy, and poor attention. There are two types of positive symptoms. The first of these is called positive psychotic symptoms. They are hallucinations or false perceptions; perceiving what is not there or failing to perceive that which does exist. These include auditory "voices inside one's head". Delusions are false beliefs; ideas that are firmly held regardless of evidence to the contrary. There are also positive disorganized symptoms including disorders of thinking and speech, bizarre behaviors, and inappropriate emotions. An example of this speech is "when you swallow in your throat like a key, it comes out, but not a scissors, a robin too, it means spring." The person may giggle, laugh, or sob for no apparent reason or stand perfectly still for hours at a time.

Question:
6. Do you think this psychological disorder can have other causes? What about the symptom of hearing voices?


The negative symptoms correlate with physical findings of enlarged ventricles in the brain, a clearer genetic basis, more severe complications at birth, a lower educational level, poor adjustment patterns in society, and poor prognosis due to ineffective response to medications. Correlated with the positive symptoms are excesses of the neurotransmitter dopamine, normal brain configuration, severe disruptions in early family life, over-activity and aggressiveness in adolescence, and a good response to treatment and medications.

Question:
7. Did Jesus heal anyone with symptoms of schizophrenia? If so, who?


It is important that even though these symptoms are not normal, the average patient with schizophrenia does not follow the stereotype of the crazed and wild lunatic that is often shown in movies and on television. On a daily basis the average patient is quite colorless, socially withdrawal, and of very little danger. Their different-ness may be frightening, but persons with schizophrenia are seldom more dangerous than anyone else. Schizophrenia means the "splitting of the mind". This term was first used in 1911 by a Swiss psychiatrist Bleuler. The split he referred to was the split of the mind of the patient from the real world and the social relationships that the rest of us have.

Question:
8. What are the differences between the positive and negative symptoms of schizophrenia?


What Causes Schizophrenia?
Since schizophrenia is a complex family of disorders, any basic conclusion about the causes will be tentative and multi-dimensional. There are several interesting hypotheses:

  1. Genetic - If there is a history of the disorder in parents, the risk of the disease is higher. Again, the risk is higher in identical twins - 40-50%. However, we need to remember that 89% of those diagnosed do not have any family history of schizophrenia.

  2. Brain - The role of the neurotransmitter dopamine has been noted in several experiments. We know that the abuse of amphetamines can lead to many of the symptoms found in schizophrenia. Amphetamines are chemically similar to dopamine and cause an increase in dopamine levels in the brain. Logic makes us think that schizophrenic symptoms are caused excess amounts of dopamine. Although dopamine is found in all human brains, it is present in high levels in late adolescence when schizophrenia usually appears.

    Support for the dopamine theory comes from examining the action of drugs that reduce schizophrenic symptoms. Some of the drugs that ease schizophrenic symptoms commonly block receptor sites for dopamine in the brain. If reducing dopamine levels in the brain eases the symptoms of schizophrenia, might these symptoms be caused by dopamine in the first place?

  3. Many patients with schizophrenia, mostly those with the negative symptoms, have brain structures that are not normal. There is a lack of balance between the two hemispheres of the brain. There is less tissue around the limbic system, a smaller thalamus, and larger crevices in the cerebral cortex. We are not sure what these differences mean, but they are confirmed.

    Question:
    9. What are some of the possible causes of schizophrenia?
    (One or more of the following answers may be correct.)
    High dopamine levels in the brain.
    Some physically traumatic event happened either in the womb or during delivery that disrupts the central nervous system of the baby.
    Genetic - your children drive you to schizophrenia.
    Brain structures that are not normal.


  4. The neuro-developmental hypothesis is gaining rapid evidence for the cause of schizophrenia. The basic notion is that some physically traumatic event happened either in the womb or during delivery that disrupts the central nervous system of the baby. The most suspect event is influenza contracted in the second third of pregnancy.

  5. In some people, the symptoms of schizophrenia remain dormant, or until the person is subject to environmental stressors. Other people faced with the same type of stress might develop ulcers, anxiety, or show no symptoms at all. It is thought that some life experiences bring on the symptoms of schizophrenia. However, the consensus among researchers is that schizophrenia is a disorder of the brain and not of life patterns. However, we do not know how this happens as of now.

10. Do you think schizophrenia could also be a spiritual illness? If so, why?