“The emptiness of
the depression turns to grief, then to numbness and back again. My world is
filled with underwater voices, people, [and] lists of things to do. They gurgle
and dart in and out of my vision and reach. But they are so fast and slippery
that I can never keep up. . . . All escapes are illusory—distractions, sleep,
drugs, doctors, answers, hope . . .” (Manning, M, 1995, p. 99). Psychological disorders and diseases have
such a huge impact on the day-to-day lives of those who suffer from them; they
involve severe cases of psychological impairment. According to Pinel (2009) some cases are “influenced
more by experiential factors …” (Pinel, 2009, p. 456). When discussing psychological disorders (e.g.
schizophrenia, depression, mania, anxiety disorders, and Tourette syndrome)
there are many items to consider, such as, associated theories of the disorder
and what, if any, are the treatments for the disorder.
Hallucinations
(e.g. hearing voices) are only one symptom of schizophrenia. The difficulty in diagnosing schizophrenia,
according to Pinel (2009), is that the symptoms are quite diverse and mirror
other psychiatric disorders. Other
diagnostic symptoms include delusions, inappropriate affect (e.g. laughing at
funerals, shouting in church), incoherent thought, and odd behavior (e.g. statuesque
poses, echolalia). According to Hao-Yan Tan,
Joseph Callicott, and Daniel Weinberger (2009) “Schizophrenia has complex
genetic heritability” (p. 277, para. 1).
One of the first psychoactive drugs identified and used for the
treatment of schizophrenic symptoms was Chlorpromazine. One of a high affinity antischizophrenic drug,
within the phenothiazine chemical class; all bind to the D1 and D2
receptors inhibiting dopamine receptors (Pinel, 2009; Tan, Callicott, &
Weinberger, 2009). Low affinity drugs
such as haloperidol and spiroperidol, indicates Pinel (2009), are within the
butyrophenone chemical class, and bind only to the D2 receptors, which
play a role in the cause of schizophrenia.
According to Tan, Callicott, and Weinberger (2009) D2
receptors are crucial for cognitive processes; thus the dopaminergic systems
are finely tuned for effective information processing. Although it takes several weeks for any of
the anti-schizophrenic drugs to take effect, there are a high percentage of patients
who cease taking his or her medication because of the side effects (e.g.
diabetes, weight gain) (Pinel, 2009).
The effects on cognitive functioning need to be better understood, as do
the experiential contributions to the disease.
Current theories of treatment center on the dopamine system; where
psychoactive drugs act as receptor blockers at the dopamine synapses.
One cannot go
through life without experiencing the loss of a loved one, the loss of a job,
or an illness that makes him or her have a deep emotional sadness (reactive
depression). However, there are those
that repeatedly experience deep emotional distress for no reason (endogenous
depression), but when that depression is to the point he or she cannot function
in a daily capacity; this is the definition of clinical depression (Pinel,
2009). Depression and mania are both psychotic
disorders of emotion; during periods of mania an individual will experience
extreme bursts of energy, impulsiveness, and over confidence. Although a manic appears to have endless
energy and drive, disaster typically trails his or her path. When depression is combined with mania, it is
known as bipolar affective disorder or manic depression, and depression with no
mania is known as unipolar affective disorder (Pinel, 2009). Whether the environment (e.g. stress) triggers
a genetic emotional state or a genetic emotional state triggers an
environmental state of stress may never be answered; however, Pinel indicates
(2009), seasonal affective disorder (SAD) is an environmental condition known
to trigger depression in individuals by depleting sunlight. Although SAD typically dissipates when the
shorter winter days give way to summer, light therapy has also proven helpful
in reducing symptoms. Whereas, treating
other affective disorders has been through a series of antidepressant drugs: “monoamine
oxidase [MOA] inhibitors, tricyclic antidepressants, lithium, and selective monoamine-reuptake
inhibitors [SSRI’s]” (Pinel, 2009, p. 463).
MOA inhibitors are used for depression but have serious side effects
when combined with foods rich in tyramine (e.g. cheese, wine, pickles);
possible risks include stroke caused by surges in blood pressure. Tricyclic antidepressants work by blocking
the reuptake of both serotonin and norepinephrine, increasing levels of both in
the brain and are, according to Pinel (2009), safer than MAO inhibitors. Lithium is used in the treatment of bipolar
affective disorder; it works as a mood stabilizer blocking the rapid shifts
between depression and mania. SSRI’s are
used for treating depression. According
to Pinel (2009) the popularity of SSRI’s is twofold “first, they have few side
effects [and] second, they are effective against a wide range of psychological
disorders in addition to depression” (p. 464).
Associated theories of affective disorders include the monoamine theory
and the diathesis-stress model theory.
The monoamine theory implicates a deficit in monoamine release, whereas
the diathesis-stress model implicates a genetic susceptibility.
“Anxiety is a
chronic fear that persists in the absence of any direct threat;” however, when
that fear becomes so severe it disrupts daily activities it is known as anxiety
disorder (Pinel, 2009, p. 466). Anxiety
disorders are classified into five categories: generalized, phobic, panic,
obsessive-compulsive (OCD), and posttraumatic stress (PTSD). Generalized anxiety is the presence of fear
or stress in the absence of a precipitating stimulus, unlike phobic anxiety
where an object (e.g. spider, snake) or situation (e.g. plan ride, crowd) is
the stimulus of the anxiety. Panic
disorders occur rapidly with severe symptoms of stress (e.g. racing heart,
sweating) and can be associated or separate from generalized or phobic
disorders. OCD is characterized by its
name; whereas, the affected person is obsessed by thoughts and impulses. He or she responds to these impulses, for
example, by repeatedly cleaning the house or locking and unlocking the
door. PTSD is a serious condition that
can develop after a person has experienced or witnessed a traumatic or
terrifying event such as war or sexual assault.
Anxiety disorders are treated slightly different from affective
disorders, with the use of antidepressants (SSRI’s), benzodiazepines, and
serotonin agonists. Because SSRI’s are known
for their multipurpose use they are often affective on anxiety disorders as
well as depression. Benzodiazepines,
more commonly known as Librium and Valium are widely prescribed to treat
anxiety. Side effects include sedation,
nausea, withdrawal reaction, and rebound anxiety as benzodiazepines are highly
addictive. Serotonin agonist affects the
5-HT1A receptor, unlike an SSRI, to produce anti-anxiety, although
its side effects are different from that of benzodiazepines producing “dizziness,
nausea, headache, and insomnia” (Pinel, 2009, p. 468). Current theories on anxiety disorder focus on
the amygdala, prefrontal lobes, and cognitive factors (Pinel, 2009).
Although someone
that does not have Tourette syndrome may never know what it is like to go through
life with an involuntarily motor or verbal tick (e.g. lewd gesture, hopping,
barking, grunting, or worse), the person whom must live with this disorder is
at the mercy of these ticks. It is yet
unknown if Tourette syndrome is genetic or environmental, although a family
history increases the risk of developing Tourette’s. Treatment has been through education, psychotherapy
for anxiety and depression, and deep brain stimulation (which has shown
promising results). Medication such as
neuroleptics, a D2 receptor blocker are provided to treat symptoms
related to conditions such as ADHD and OCD; currently response to treatment is
moderate (Pinel, 2009; Mayo Clinic, 2010).
Additional theories are leaning toward the hypothesis that Tourette
syndrome is a neurodevelopmental disorder…
Just as those who
suffer from psychological disorders such as schizophrenia, affective disorders,
anxiety disorders, and Tourette syndrome fight to find the normalcy in his or
her daily life, there is someone struggling to understand what he or she is
going through to improve upon those challenges.
The more that can be understood both physically and psychologically
about each of these disorders and diseases, the closer society will come to
producing a solution that will treat and possibly cure each psychological
disorder that plagues the depths of the mind and body. A slow and arduous task that cures one
ailment while causing another; making it impossible to take at times. However, our hope for a cure lays in the
future, every evolving and every changing.
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