Analyzing Psychological Disorders

Psychological disorders are classified in a variety of ways, differentiated by behavioral symptoms. Classification of psychological disorders include: anxiety disorders, somatoform disorders, dissociative disorders, schizophrenia, and bipolar disorder. However, one disease not listed is addiction. Addiction is a psychological disorder which is hidden behind substance abuse. The onset of a psychological disorder can be noticed either early or late in life; there is no age these disorders favor more. Psychological disorders do not discriminate against race, gender, or socioeconomic status. There are many potential causes of a psychological disorder. People can be predisposed with the genetics that have the potential to become a psychological disorder or addiction. Other people may have environmental factors that predispose them to a psychological disorder or a combination of both.

My Understanding of the Causes and Treatments of Schizophrenia

Schizophrenia affects 1% of the general population, with a 10% increased risk to those who have a parent or sibling with schizophrenia. According to the National Alliance on Mental Illness (1996, para. 4), “Many people living with schizophrenia do not believe themselves to be ill.” Schizophrenia typically beings in early adulthood and the symptoms can change over time with any combination of symptoms. Two or more symptoms must be present for at least one month before making a diagnosis of schizophrenia. This disorder can be caused by abnormal genes, hereditary, and environmental factors. The treatment of schizophrenia includes a variety of medication and therapy to relieve the symptoms caused by schizophrenia.

Areas of the Brain Affected by Schizophrenia

Many areas of the brain are affected by schizophrenia: the forebrain, hindbrain, and limbic system. According to the National Alliance on Mental Illness (2011, para 10), “A 2001 study found that whole brain, grey matter, and white matter are largely influenced by genetic factors.” Individuals with schizophrenia have “changes in both structure and chemistry” (National Alliance on Mental Illness, 2001, para. 10) of the brain. Schizophrenia causes many structural changes in the brain; reduced volume of grey matter, reduced brain volume and activity, larger than normal ventricles and basal nuclei, smaller amygdala and hippocampus. Functional circuits in the brain are thought to become disrupted by schizophrenia. The circuits involved with schizophrenia are the gyrus, hippocampus, amygdala, and the thalamus. Blood flow to the brain is also affected by schizophrenia.

The Neural Basis of Schizophrenia

The prefrontal lobe shows “excessive activity at the dopamine synapses” (Pinel, 2009, p. 98). Serotonin reacts to the overabundance of released dopamine in the brain and modifies the way the brain operates. According to Lundbeck Institute (n.d., para. 4), “An imbalance in the concentrations of dopaminergic and glutametergic systems in the brain is also thought to play a role in the development of schizophrenia.” An imbalance in one neurotransmitter can affect other neurotransmitters which are not susceptible to schizophrenia. The D2 dopamine receptor is a key influence to schizophrenia. During fetal development, inappropriate connections between the neurons can occur and initiate schizophrenia. Infection or intrauterine starvation can cause these connections, which remain dormant until the reorganization of neurons in the brain occurs during puberty or in young adulthood.

Associated Symptoms of Schizophrenia

According to the National Alliance on Mental Illness (2011, p. 1), “The symptoms of schizophrenia are divided into three categories: positive, negative, and cognitive symptoms.” Positive symptoms of schizophrenia are those that interact with the world in some way. Some positive symptoms of schizophrenia include delusions and hallucinations. Delusions occur when the person with schizophrenia produces “false memories without a deliberate intent to lie” (National Alliance on Mental Illness, 2011, p. 1). Negative symptoms are those behaviors that take away the person from interacting with the world. Some negative symptoms include emotional flatness, inappropriate affect, lack of content in speech, lack of follow through with activities, and lack of pleasure. Cognitive Symptoms include the executive functioning of the brain: memory and thought organization. Many people with schizophrenia experience difficulty with processing visual events and auditory sounds. Those living with schizophrenia may visualize something false or hear loud voices which are not there.

Causal factors of Schizophrenia

The cause and course of the illness is unique for each person; the onset of illness is often associated with a distressful period in life. Although a specific cause of schizophrenia is not known, some influential factors include genetics, environment, substance abuse, and brain structure. These multiple causes have been known to influence the onset of schizophrenia. A collection of “specific genes have been shown to influence the risk for developing schizophrenia” (National Alliance on Mental Illness, 2011, para. 8). No single gene is responsible for causing schizophrenia alone, but rather several types of genes associated with schizophrenia have the potential to cause this disease. Early factors such as traumatic injury, birth complications, early infections, toxins, autoimmune reactions, and stress have been implicated with schizophrenia (Pinel, 2009, p. 458). The course of neurodevelopment may be altered with early traumatic experiences, which may influence schizophrenia. The use of substance abuse is believed by some, to be a cause for schizophrenia; others disagree. It is known that those who abuse substances are less likely to seek treatment for schizophrenia.

Appropriate Drug Therapies for Schizophrenia

According to Pinel (2009, p. 98), “The drugs that most effectively block it (the D2 dopamine receptor) are the most effective anti-schizophrenic drugs.” There are two generations of antipsychotic medications available to those suffering with schizophrenia; first-generation (typical antipsychotics) and second-generation (atypical antipsychotics). The first generation of medications began in the 1950s; and include Chlorpromazine, Haloperidal (Haldol), Loxapine, and Fluphenazine. Typical antipsychotics reduce hallucinations and delusions. However, the side effects include restless motion, Parkinson-like symptoms, and tardive dyskinesia (National Alliance on Mental Illness, 2011). The second-generation of medications are called atypical antipsychotics, released in the early 1990s. These medications for schizophrenia include Clozapine, Abilify, Zyprexa, Risperdal, Seroquel, and Geodon. Atypical medications are often recommended because they do not cause movement problems. Clozapine is the most effective drug in reducing difficult-to-treat symptoms; however, the loss of white blood cells is a serious side effect. Other side effects of the atypical medications include rapid heartbeat, drowsiness, and blurred vision; more serious side effects include elevated blood pressure, metabolic syndrome, and abdominal obesity. The help of these medications have improved life for many people suffering with schizophrenia.

Major Case: Drug Abuse

Ron is a 33-year-old self-admitted alcoholic who started drinking during his adolescence. The seriousness of drinking began in his late 20s when he was arrested several times for drinking under the influence (DUI). Having been through a variety of treatment programs and extensive police involvement, Ron cannot control his drinking. Relapses of sobriety are common with Ron. The negative consequences of his drinking are making life more difficult for Ron and his wife. His drinking is affecting his personal life.

The problem in this case from the perspective of a biopsychologist

Ron started drinking during his adolescence, when neurons in the brain begin to change. In his early 20s, Ron’s alcohol tolerance began to increase. “Most alcohol tolerance is functional.” (Pinel, p. 381) Ron is unable to control his drinking and has been through inpatient treatment in the past, which was unsuccessful. Ron continues to relapse into daily use of alcohol, despite his arrests for driving under the influence.

The problem in this case in relation to the nature-nurture issue

Alcohol was accessible to Ron during his adolescence which fueled the tolerance level. As the tolerance level of alcohol increased, the neurons in the brain began to connect and respond differently.”Many individuals with alcohol problems suffer from other mental health conditions, such as severe anxiety and depression, at the same time” (American Psychological Association, 2011, para. 9). Possible causes of Ron’s alcohol problem could be linked to genetic factors, psychological factors, physiological factors, or social factors. Some people are predisposed genetically to alcoholism or addiction. Ron may have started drinking for social approval or other environmental factors. His motivation for recovery is evident but lacks the follow through to stay sober.

Helpful drug interventions or solutions

According to Enoch, M.A. and Goldman, D. (2002, para. 20), “Alcohol dependence is treated in two stages: withdrawal and detoxification, followed by further interventions to maintain abstinence.” I believe Ron needs help with remaining sober not becoming sober. Sustained treatment should include behavioral treatment approaches: inpatient treatment, a 12-step program (Alcoholics Anonymous) and cognitive-behavior therapy (CBT). Ron can work through his problems in inpatient treatment, and the staff can monitor his recovery with possible medication of naltrexone. When Ron completes his impatient treatment, depending on how severe his case, he should have a support network available of friends, family, and others in recovery to help Ron through any triggers. Success of the treatment includes support and the willingness of Ron to call on others when needed.

Positive or negative aspects of these drug interventions or solutions

Naltrexone is and anti-craving mediation, used to reduce the cravings for alcohol and treat affected neurotransmitters in the brain (Enoch & Goldman, 2002). Some negative side effects of naltrexone include nausea, anxiety, dizziness, blurred vision, and confusion. Cognitive-behavioral skills treatment can help Ron identify triggers for his drinking, learn new methods of coping with high-risk situations. The 12-step program can help Ron develop positive social connections with others in recovery to use as a support system when he is in high-risk situations.

Major Case: Anxiety

Tom is a married man with three children and a respectable career. Tom worries incisively about his health, money, and responsibilities. This excessive worry is interfering with his health; common complaints include headaches, muscle tension, and hot flashes. Tom also experiences irritability, nausea, fatigue, difficulty concentrating, sleep problems, and ability to function at work when he feels anxious. For 6 months, Tom has been trying to resolve the problems alone, which are not working.

The problem in this case from the perspective of a biopsychologist

Tom may have a genetic predisposition to anxiety but the likely cause is environmental factors. The health problems Tom experiences physical problems of headaches, muscle tension, and hot flashes which are the body’s cue something is wrong. Tom focuses on the stressors of life, ignoring the signals to pay attention to his body. Medication can help alleviate the symptoms of anxiety while working through the underlying issues in therapy.

The problem in this case in relation to the nature-nurture issue

There are five classes of anxiety disorders: panic disorder, phobias, obsessive-compulsive disorder, posttraumatic stress disorder, and generalized anxiety disorder. Tom fits the description of experiencing a generalized anxiety disorder. Tom is responsible for his wife and three children; he also has important responsibility at his job. His constant worry about his family and job contribute to his stress. “Causes of anxiety disorders are currently unknown” (American Psychiatric Association, 2011, para. 16). A combination of environmental stresses and genetic influence can produce an anxiety disorder (American Psychiatric Assocaition, 2011, para. 16). Gene responsibility has not been located; however, fear responses in the brain may influence a generalized anxiety disorder. A number of factors can trigger an anxiety disorder; stress, inefficient coping mechanisms, family history, and genetics. “Other anxiety disorders, depression, or substance abuse often accompany GAD, which rarely occurs alone” (The National Institute of Mental Health, 2009, para. 5). Certain neurotransmitters in the brain, such as noradrenaline and serotonin regulate anxiety. I would recommend treating Tom’s generalized anxiety disorder with medication and cognitive-behavioral therapy. Any other unknown issues will likely come out during therapy and can be resolved.

Helpful drug interventions or solutions

The best treatment for generalized anxiety disorder is psychotherapy and medication. “Cognitive-behavioral therapy (CBT) is very useful in treating anxiety disorders” (National Institute of Mental Health, 2009, para. 19). Therapy will focus on identifying triggers, understand symptoms, and change thinking and behavioral patterns. Dialectical behavioral therapy is also used to treat generalized anxiety and involves two components: individual therapy and group therapy. Dialectical Behavioral Therapy (DBT) teaches mindfulness, tolerating distress, regulating emotions, and learning new skills for interpersonal effectiveness, tolerating distress, regulating emotions.

According to the National Institute of Mental Health (2009, para. 4), “The principle medications used for anxiety disorders” are antidepressants, anti-anxiety drugs, selective serotonin reuptake inhibitors (SSRIs), tricyclics, monoamine oxidase inhibitors (MAOIs), and beta-blockers, which are effective at relieving symptoms of anxiety disorders. The more common medications used to treat generalized anxiety disorder include Venlafaxine, imipramine, clonazepam (Klonopin), alprazolam (Xanax), and buspirone.

Positive or negative aspects of these drug interventions or solutions

Antidepressant medication takes 4 to 6 weeks before a decrease in symptoms and improvement occurs. Venlafaxine (Effexor) is a drug closely related to the SSRIs (National Institute of Mental Health, 2009). Imipramine (Tofranil) is a tricyclic. Clonazepam (Klonopin), alprazolam (Xanax), and buspirone are benzodiazepines (anti-anxiety drugs). These drugs all help reduce the symptoms and behaviors associated with generalized anxiety disorder. Side effects of Effexor include nausea, jitters, and sexual dysfunction. Tofranil can cause dizziness, dry mouth, weight gain, and drowsiness. Klonopin and Xanax are high-potency drugs which have fewer side effects, but are more addicting. Buspirone is a newer anti-anxiety drug and has side effects such as headaches, nausea, and dizziness. Medication may need to be altered many times to achieve the correct treatment option for Tom.

During the cognitive-behavioral therapy, Tom can work through stressful issues and learn new coping skills, communication techniques, and change cognitive thinking patterns. Cognitive-behavioral therapy may lead to an undiagnosed psychological disorder or addiction. His wife can be involved in part of the therapy sessions so she can better understand Tom and his issues. Tom’s wife will be a beneficial asset to Tom’s recovery.

Psychological disorders can affect anyone, at any time during their life. The prognosis for those who have a mental disorder is positive with the help of medication and cognitive-behavioral therapy. Many times a diagnosis of one mental illness can lead to other disorders or illnesses; this is referred to as co-morbid disorders. The prevalent disorder will overshadow other psychological disorders that occur at the same time. Many times alcoholism is overshadowing depression or anxiety. During cognitive-behavioral therapy, other disorders (such as depression) can become evident, at which time a medication may be given to help that disorder.

Both of the above case studies possibly have the same underlying diseases but are treated differently. When treating psychological disorders, it is important to address the possibility of both, the addiction and mental illness. Treatment is more successful if the person wants help and is willing to make the changes needed to treat the problems. Many people with a psychological disorder live successful happy lives with the help of medication, therapy, and a supportive network of friends, family, and other individuals with anxiety.

References

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American Psychological Association. (2011). Understanding Alcohol Use Disorders and Their Treatment. Retrieved December 7, 2011 from apa.org

Anxiety Disorders Association of America. (2011). Therapy. Retrieved December 7, 2011 from adaa.org

Enoch, M. A. and Goldman, D. (2002) American Academy of Family Physicians. Problem Drinking and Alcoholism: Diagnosis and Treatment. Retrieved December 7, 2011 from aafp.org

Lundbeck Institute. (n.d.). Focus on Brain Disorders. Schizophrenia. Aetiology. Retrieved December 5, 2011 from brainexplorer.org

National Alliance on Mental Illness. (2011). Schizophrenia. The Causes of Schizophrenia. Retrieved December 5, 2011 from nami.org

National Alliance on Mental Illness. (2011). Schizophrenia. The Symptoms of Schizophrenia. Retrieved December 5, 2011 from nami.org

National Alliance on Mental Illness. (2011). Schizophrenia. Treatment, Services and Support. Retrieved December 6, 2011 from nami.org

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Tormoehlen, K. and Lessick, M. (2011). Nursing for Women’s Health. Schizophrenia in women. DOI: 10.111/j1751-486X.2010.01595.x