Category Archives: Health

Health

Spleen

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The spleen is an organ that is present in all vertebrate animals, though the spleen often alludes thought in most people (Steiniger, 2005).  The human spleen is a red color, ovular mass that is roughly the size of a clenched fist located in the Upper Left Quadrant of abdominal peritoneum (Strickland and Lloyd, 2007).  The average spleen weighs around 200g and has an average volume around 215 mL, though this varies in correlation to body height, weight, body mass index, and body surface area (Caglar et al. 2014).  Located in the dorsal region and resting against the diaphragm, the spleen in not able to be palpated in medical examination (Strickland and Lloyd, 2007).  The spleen is a lymphatic organ, which deals with the immune system of the body (Steiniger, 2005).  The function of the spleen is separated into two different anatomical sections, which are the red pulp and the white pulp (Steiniger, 2005).

The red pulp is composed of splenic sinuses, which connect the veins with the arterioles and is not found in all species of vertebrates, and splenic cords, which are composed of loose connective tissue (Steiniger, 2005).  The blood filled splenic sinuses is what the “red pulp” region of the spleen is named for (Mebius and Kraal, 2005).  The red pulp filters the blood through phagocytosis by the macrophages found in this region (Steiniger, 2005).  This filtering of the blood can remove dangers to the body such as microorganisms, leukocytes covered in immune complexes, and old or abnormal red blood cells (Steiniger, 2005).  The blood flows into region through arteries into cords that are composed of fibroblasts and reticular fibers that does not have an endothelial lining, and continues into the venous sinuses that do contain endothelial lining (Mebius and Kraal, 2005).  After the venous sinuses, a structure that contains a series of stress fibers that are connecting the endothelial cells to the part of the extracellular matrix made-up of actin and myosin filaments (Mebius and Kraal, 2005).  This structure that is created allows passage from the venous sinuses only through the spaces between the stress fibers (Mebius and Kraal, 2005).  Active cells are located in these spaces that are set off by foreign substances, especially bacteria, and activate the antibodies to remove them (Strickland and Lloyd, 2007).  This creates difficulty for erythrocytes whose membranes have become stiff with age, and those who are unable to pass through go through phagocytosis (Mebius and Kraal, 2005).  Macrophages in this area can also remove substances from abnormal erythrocytes without effecting them; these substances include leftover pieces of nuclear DNA, altered hemoglobin, and iron (Strickland and Lloyd, 2007).  Stress fibers may also contract preventing the pass of all erythrocytes, creating a reservoir of blood and thus reducing stress and viscosity while the body is at rest (Mebius and Kraal, 2005).

Another function of the red pulp that arises from the removal of old erythrocytes, is to recycle iron with the use of macrophages while working with the macrophages within the liver (Mebius and Kraal, 2005; Strickland and Lloyd, 2007).  The erythrocytes are broken down by a vesicle called a phagolysosome, which is formed from the fusion of a phagosome and a lysosome, this vesicle then releases a compound that contains iron (Mebius and Kraal, 2005).  This compound, called haem, is further broken down into its components of biliverdin, carbon monoxide, and ferrous iron (Mebius and Kraal, 2005).  The iron is originally stored within the macrophages and is later sent to the bone marrow to be used again (Strickland and Lloyd, 2007).

The white pulp in the spleen plays a large role in the immune system (Mebius and Kraal, 2005).  Two compartments within the white pulp store B-cells and T-cells seperately, and these compartment resemble lymph nodes (Mebius and Kraal, 2005).  The B-cells, or B-lymphocytes, serve in the process of filtering the blood when the blood must fit through the space with the stress fibers, and are a location for producing antibodies after the cells are activated in response to a foreign body (Strickland and Lloyd, 2007).  When the T-cells, or T-lymphocytes, leave the white pulp, they go to the red pulp in an area called the periarteriolar lymphatic sheath, where they stay until they exit the spleen and circulate the body (Steiniger, 2005).  Chemokine receptors in the white pulp determine that the T-cells and B-cells are stored in the proper compartments, and also attract plasmablasts that will travel a bridging channel between the T-cell zone of the white pulp into the red pulp where they will become plasma cells (Mebius and Kraal, 2005).

Two main general problems that effects the spleen are the swelling or enlargement of the spleen (splenomegaly) and the rupture of the spleen (Mayo Clinic, 2013b; Al-Kindi et al., 2009).  There are many causes of splenomegaly, which include viral infections (e.g. mononucleosis), bacterial infections (e.g. syphilis or endocarditis), parasites (e.g. malaria), cirrhosis of the liver, several types of hemolytic anemia (early break down of red blood cells), cancers of the blood (e.g. leukemia), disorders of the metabolism, sickle cell disease, pressure or blood clots within the veins of the spleen or liver, or hydatid cysts (Mayo Clinic, 2013b; Oussama et al. 2014).  Splenomegaly may have no symptoms at all in some cases, while others may experience pain or a feeling of being full in Upper Left Quadrant with radiating pain into the left shoulder, a lack of appetite or a smaller appetite than normal, anemia (low iron levels), fatigue, frequent illness or infection, and bleeding easily (Mayo Clinic 2013b).  Diagnosis for splenomegaly may include palpation, blood test that report the complete blood count checking the red blood cells, white blood cells, and platelets, an ultrasound or a computerized tomography (i.e. CT scan) to measure the size of the spleen and its effect on surrounding organs, or a magnetic resonance imaging (i.e. MRI) to follow the blood flow through the organ (Mayo Clinic, 2013b).  Blunt force injuries or non-penetrating injuries can cause the spleen to rupture, and in the causes of these injuries, is the abdominal organ that is most commonly injured (Al-Kindi et al., 2009).  Injuries to cause a spleen rupture occur in cases involving fights, automobile accidents, falls, sports, gunshots, serious cases of mononucleosis, AIDS, malignant growths, peliosis (a vascular disorder), granuloma (masses of granulated tissue), sickle cell disease, a disruption in the blood supply, or hydatid cysts (Mayo Clinic 2013a; Oussama et al. 2014).  Symptoms associated with the rupture of the spleen include pain in the Upper Left Quadrant, tenderness when the Upper Left Quadrant is palpated, feeling light headed or dizzy, and a confused mental state (Mayo Clinic 2013a).  Diagnostic tests to determine a rupture of the spleen include a physical exam while palpating the abdomen, inserting a needle into the abdomen to draw fluids out to check for blood, and a CT scan or other imaging tests (Mayo Clinic 2013a).

Although it holds many risks, a viable option for unalleviated splenomegaly and for a ruptured spleen is splenectomy, and can reduces the rate of reoccurrence that could see reoperation and also reducing the rate of complications in a partial splenectomy or surgery to part of the spleen which could cause hemorrhaging (Oussama 2014).  One of the most common and most serious complications following a splenectomy is the risk for infection (Tanaskovic et al., 2015).  Infection is a higher risk after the removal of the spleen because the function of filtration allowing for detection and removal of antigens is no longer occurring, infection can be prevented through vaccinations, especially for pneumococci (e.g. Prevnar) once before or immediately following surgery and every five years following surgery, an influenza vaccine every year, and meningococci (e.g. Menactra) and Haemophilus influenza (e.g. Hib) before surgery if possible, also a regiment of penicillin for life may be offered (Strickland and Lloyd, 2007; Tanaskovic et al., 2015).  Other complications of splenectomy may include hemorrhage, gastric dilation due to stomach manipulation, pancreatic fistula (i.e. trauma to the pancreas), and a subphrenic abscess, sepsis (caused by Escherichia coli) (Strickland and Lloyd, 2007).

Al-Kindi, H., Devi, L., George, M. (2009). Splenic Pathology in Traumatic Rupture of the

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Oussama, B., Makrem, M., Karim, A., Brahim, K., Mohamed, B.M., Samy, B. (2014). Surgical

treatment and outcomes of hyadatid cyst of the spleen. Open Journal of Gastroenterology.

2; 51-55

Caglar, V., Kumral, B., Uygur, R., Alkoc, O.A., Ozen, O.A., Demirel, H. (2014).  Study of

Volume, Weight and Size of Normal Pancreas, Spleen and Kidney in Adult Autopsies.

Forensic Medicine and Anatomy Research. 2; 63-69.

Enlarged Spleen (splenomegaly) [Internet]. Rochester (MN): Mayo Clinic; [updated 26 July

2013; cited 13 April 2016]; [about 4 p.]. Available from:

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20029324?p=1

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Immunology. 5; 606-616.

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April 2016]; [about 3 p.]. Available from: http://www.mayoclinic.org/diseases-

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Vaccination after Splenectomy. Acta facultatis medicae Naissensis. 32; 279-286.

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Attention Deficit/Hyperactivity Disorder (ADHD)

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  1. Symptoms: Hyperactivity (squirming, fidgeting, and restless behavior); attention deficit (distractibility, frequent shifts from one uncomplete activity to another, careless mistakes, poor organization or effort, and general “spaciness”); struggle with learning far more than behavior control; several symptoms begin before the age of 12; want to “be good”, but are impulsive and have trouble behaving
  2. Diagnosis:
    1. A persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development, as characterized by (i) and (ii):
      1. Inattention: 6 (or more) of the following symptoms have persisted for at least 6 months to a degree that is inconsistent with developmental level and that negatively impacts directly on social and academic/occupational activities (Note: the symptoms are not solely a manifestation of the oppositional behavior, defiance, hostility, or failure to understand tasks or instructions. For older adolescents and adults age 17 and older, at least 5 symptoms are required):
        1. Often fails to give close attention to details or makes careless mistakes in schoolwork, at work, or during other activities (overlooks or misses details, work is inaccurate)
        2. Often has difficulty sustaining attention in tasks or play activities (has difficulty remaining focused during lectures conversations or lengthy reading)
        3. Often does not seem to listen when spoken to directly (mind seems elsewhere, even in the absence of any obvious distractions)
        4. Often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (starts tasks but quickly loses focus and is easily sidetracked)
        5. Often has difficulty organizing tasks and activities (difficulty managing sequential tasks; difficulty keeping materials and belongings in order; messy, disorganized work; has poor time management; fails to meet deadlines)
        6. Often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort (schoolwork or homework; for older adolescents and adults, preparing reports, completing forms, reviewing lengthy papers)
        7. Often loses things necessary for tasks or activities (school materials, pencils, books, tools, wallets, keys, paperwork, eyeglasses, mobile phone)
        8. Is often easily distracted by extraneous stimuli (for older adolescents and adults, may include unrelated thoughts)
        9. Is often forgetful in daily activities (daily chores, running errands; for older adolescents and adults, returning calls, paying bills, keeping appointments)
      2. Hyperactivity and impulsivity: 6 (or more) of the following symptoms have persisted for at least 6 months to a degree that is inconsistent with developmental level and that negatively impacts directly on social and academic/occupational activities (Note: the symptoms are not solely a manifestation of the oppositional behavior, defiance, hostility, or failure to understand tasks or instructions. For older adolescents and adults age 17 and older, at least 5 symptoms are required):
        1. Often fidgets wit or taps hands or feet or squirms in seat
        2. Often leaves seat in situations when remaining seated is expected (leaves his or her place in the classroom, in the office or other workplace, or in other situations that require remaining in place)
        3. Often runs about or climbs in situations where it is inappropriate (note: in older adolescents and adults, may be limited to feeling restless)
        4. Often unable to play or engage in leisure activities quietly
        5. Is often “on  the go” acting as if “driven by a motor” (is unable to be or is uncomfortable being still for an extended time, as in restaurants, meetings; may be experienced by others as being restless or difficult to keep up with)
        6. Often talks excessively
        7. Often blurts out an answer before the question has been completed (completes people’s sentences; cannot wait for turn in conversation)
        8. Often has difficulty waiting his or her turn (while waiting in line)
        9. Often interrupts or intrude on others (butts into conversations games, or activities; may start using other people’s things without asking or receiving permissions; for adolescents and adults, may intrude into or take over what others are doing)
    2. Several inattentive or hyperactive-impulsive symptoms were persistent prior to the age of 12
    3. Several inattentive or hyperactive-impulsive symptoms are present in 2 or more settings (home, school, work; with friends or relatives; in other activities)
    4. There is clear evidence that the symptoms interfere with, or reduce the quality of, social, academic, or occupational functioning
    5. The symptoms do not occur exclusively during the course of schizophrenia, or other psychotic disorder and are not better explained by another mental disorder (mood disorder, anxiety disorder, dissociative disorder, personality disorder, substance intoxication or withdraw)
  3. Course and Outcome: hyperactivity typically declines during adolescents, but attention deficits and impulsivity are more likely to continue ; prognosis for ADHD depends on whether or not there is a comorbid condition with oppositional defiant disorder or conduct disorder
  4. Frequency of Disorder: 9.5 % of children in the US have a lifetime diagnosis; 1 to 2% of children in Europe receive the diagnosis; diagnosis in the US increased by 2/3 between 2000 and 2010; more common among children of more affluent parents; 2 to 10 times as many boys as girls have externalizing problems
  5. Etiology:
    1. Family risk factors: increase fourfold when 2 are present and further when 3 or 4 are present: low income, overcrowding in the home, maternal depression, paternal antisocial behavior, conflict between parents, removal of child from the home
    2. Biological factors:
      1. Difficult temperament (inborn behavioral characteristics, including activity level, emotionality, and sociability)
      2. Neuropsychological abnormalities: brain damage was present on a CT scan in 5% of ADHD cases; many do not show soft signs (delays in fine motor coordination); minor anomalies in physical appearance, delays in reaching developmental milestones, maternal smoking and alcohol consumption, pregnancy and birth complications
      3. Genetics: couple be a single gene or could be polygenetic
      4. Social factors: socialization (process of shaping children’s behavior and attitudes to conform to the expectations of parents, teachers, and society)
      5. Parenting styles
      6. Coercion
      7. Negative attention: what seems to be a “punishment” sometimes may reinforce misbehavior
      8. Inconsistency in rules and expectations especially from parent to parent
      9. Influence of peers, neighborhoods, and media
      10. Psychological factors: low self-esteem, overestimation of self, self-protection, lack of self-control, delay of gratification
  6. Treatment:
    1. Psychostimulants (Ritalin, Dexedrine, Cylert, Adderall) increases alertness, arousal, and attention; shows improvements in behavior in about 75% of children with ADHD; taken for years, not days or weeks
    2. Antidepressants affect symptoms for unknown reasons
    3. Strattera for adults with ADHD and is the only nonstimulant medication approved by the US Food and Drug Administration
    4. Clonidine decreases aggressive behavior
    5. Behavioral Family Therapy (BFT) teaches parents to be very clear and specific about their expectations for children’s behavior to monitor children closely, and systematically reward positive behavior while ignoring or mildly punishing misbehavior; parent training; star charts or daily report cards; teaches punishment strategies such as time outs; rewards need to out weight punishments; goals is to teach authoritative parenting; benefits are generally limited to children under the age of 12; less effective when parents are unhappily marries, depressed, substance abusers, or harsh and critical with their children
    6. Problem-solving skills training (PSST) is one technique which children are taught to slow down, evaluate a problem, and consider alternative solution before acting
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Autism Spectrum Disorder (ASD)

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  1. Symptoms: impairments in social interaction; social communication, and restricted, repetitive behavior; motor milestones may be reached late, and movement may appear awkward or rather uncoordinated; may see abnormalities from birth; in 20 to 40% or severe cases, the baby develops normally for a time but either stops learning new skills or loses the skills acquired earlier; look less at objects held by others; engage in more repetitive motor movements; restrictive, repetitive patters or behavior, interests, or activities; unusually fascinated with some activity; self-stimulation; respond to sound, touch, sight or smell in unusual ways; apparent sensory deficits (organ is not impaired by actions make it appear so); savant performance (exceptional ability in a highly specialized area of functioning often in areas of art, music, or mathematics)
    1. Social communication deficits: normal language accompanied by odd “body language” at one extreme to a total absence of verbal and nonverbal communication at the other; failure to develop normal speech; about half are mute; dysprosody (subtle disruptions in rate, rhythm, and in tone of speech); echolalia (uttering phrases back, perhaps repeatedly)
    2. Social impairment deficits: range from relatively mild problems with social or emotion reciprocity; in severe ASD cases, they have no interest in relationships and treat people like confusing, foreign objects; lacking theory of mind (failure to appreciate that other people have a different point of reference); deficits tend to be emotional and not cognitive; missing basic motivation to form attachments; gaze aversion
    3. Self-injurious behavior: repeated head banging and biting the fingers and wrists; may involve major bruises or they can be as severe as broken bones, brain damage, or death; is not suicidal behavior
  2. Diagnosis:
    1. Persistent deficits in social communication and social interaction across multiple contexts, as manifested by the following, currently or by history (examples are illustrative, not exhaustive):
      1. Deficits in social-emotional reciprocity, ranging, for example from abnormal social approach and failure of normal back-and-forth conversation; to reduced sharing of interests, emotions, or affect; to failure to initiate or respond to social interactions
      2. Deficits in nonverbal communicative behaviors used for social interactions, ranging, for example, from poorly integrated verbal and nonverbal communication; to abnormalities in eye contact and body language or deficits in understanding and use of gestures; to a total lack of facial expressions and nonverbal communications
      3. Deficits in developing, maintaining, and understanding relationships, ranging, for example, from difficulties adjusting behavior to suit various social contexts; to difficulties in sharing imaginative play or in making friends; to absence of interest in peers
      4. Specify current severity
    2. Restricted, repetitive patterns of behavior, interests, or activities, as manifested by at least two of the following, currently or by history (examples are illustrative not exhaustive)
      1. Stereotyped or repetitive motor movements, use of objects, or speech (e.g., simple motor stereotypies, lining up toys or flipping objects, echolalia, idiosyncratic phrases)
      2. Insistence on sameness, inflexible adherence to routines, or ritualized patterns of verbal or nonverbal behavior (e.g., extreme difficulties with transitions, rigid thinking patterns, greeting rituals, need to take same route or eat same food everyday)
      3. Highly restricted, fixated interests that are abnormal in intensity or focus (e.g., strong attachment to or preoccupation with unusual objects, excessively circumscribed or perseveration interests)
      4. Hyper or hypoactivity to sensory input or unusual interest in sensory aspects of the environment (e.g., apparent indifference to pain/temperature, adverse response to specific sounds or textures, excessive smelling or touching of objects, visual fascination with lights or movements)
      5. Specify current severity
    3. Symptoms must be present in the early developmental period (but may not become fully manifest until social demands exceed limited capacities, or may be masked by learned strategies later in life)
    4. Symptoms cause clinically significant impairment in social, occupational, or other important areas of current functioning
    5. These disturbances are not better explained by an intellectual disability (intellectual developmental disorder) or global developmental delay.  Intellectual disability and autism spectrum disorder frequently co-occur; to make comorbid diagnoses of autism spectrum and intellectual disability, social communication should be below that expected for general developmental level
  3. Course and Outcome: the sooner children that are diagnose earlier can be treated more successfully and may have an increase in IQ; no cure; more children and adults are now being cared for in their homes and communities instead or institutions; a more positive outcome can be predicted by language skills at the age of 5 or 6; joint attention (coordinating attention with another person through gestures, social responding, or social initiation, predicts language development from preschool age to 9; a quarter or more of young people with classic autism develop seizure disorder as teenagers; in adults, affective disorders are common
  4. Frequency of Disorder: 200 in 10,000 (1 in 50) suffer from ASD; a 400% in prevalence of ASD between 1998 and 2007, and a 300% prevalence by 2012; four times as many boys as girls suffer from ASD (suggests it stems from fragile-X syndrome)
  5. Etiology:
    1. fragile-X syndrome
    2. Genetics: in 60% of monozygotic twins, if one has ASD the other does too; possible genetic mutation
    3. Neuroscience: larger than average brain; unusually rapid brain growth until the age of 2 or 3; smaller volume than normal of the vertebral and cerebellar brain; abnormalities in the cerebellum and limbic system and the frontal lobe; mirror neurons fires both when an individual performs an action and when the individual observes another performing the same action; abnormalities in endorphins and neuropeptides
  6. Treatment(s):
    1. Medication: many medications are misused for ASD; antipsychotic (risperidone) helps in behavior management; SSRIs may also help with some stereotyped behavior; no medication is considered an effective treatment
    2. Applied Behavior Analysis: most promising approach to treating classic autism; focuses on treating specific symptoms including communication deficits, lack of self-care skills, and self-stimulatory or self-destructive behaviors; sets specific and small goals; attempts to teach language; first goal in to identify very specific target behaviors, the second goal is to gain control over these behaviors through the use of reinforcement and punishment; efforts must be rewarded repeatedly with primary reinforcements such as a favorite food, at least in the beginning phases of treatment; concentrate on reducing the excess of self-stimulations, self-injurious behaviors, and general disruptiveness, as well as teaching new skills to eliminate deficits in self-care and social behavior; sometimes uses a gentle slap or a mild shock to reduce or eliminate potentially dangerous behaviors such as head banging
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The Notebook: Developmental Stages

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In the 2004 movie, The Notebook, a dramatic love story between Noah Calhoun and Allie Hamilton.  The movie begins with an elderly man reading out of a notebook to an elderly woman as they are patients at a nursing home, both probably in their eighties.  The story follows the elderly two throughout their day as he reads her the story.  The story that is in the notebook tells the long forlorn love story of a wealthy seventeen year old, Allie, and the poor eighteen year old country boy, Noah.  The first part of the story retells a tale of summer love that eventually ends poorly when Allie’s parents forbid her to see Noah ever again.  The story continues on, giving short details of how their lives are proceeded separate from each other.  When the two come to be in their mid to late twenties, Allie who is pledged to get married to another man, but when she sees Noah’s picture in the paper with the house he promised to restore for her so many years before, she returns to see him.  In the end Allie must choose between her fiancé and Noah, and chooses to stay with Noah.  In this paper I am specifically examining Noah in early adulthood, and Allie in elderhood.  Two main developmental aspects that Noah experiences in early adulthood are how he copes with isolation, specifically with loneliness and depression, and also his exploration of intimate relationships.  In elderhood for Allie two main focuses of development are dementia and living arrangements within the nursing home.

First, Noah is coping with isolation quite a bit.  He is still working through the loss of the love of his life, Allie, his father’s death, and also, his saw his best friend die in the war.  After the war, Noah came back and spent most of his time with his father, but when his father died, he has no one left.  Noah would sleep with Martha Shaw, who was made a widow by the war, and this was the only contact made visible in Noah’s life in the movie.  As it is said in the movie, Noah used Martha Shaw to cover the loneliness that was resulting from the void left when Allie was torn out of his life.  All the events that have occurred with the loss of Allie and the death of both Fin and his father seems to have caused Noah to be greatly depressed, which he copes with by heavily drinking alcohol.  The only thing that seems to improve Noah’s loneliness and depression is the return of Allie.  Instead of working through this during the roughly ten year period since Allie left the first time, he instead continues to wallow in the loss of his love until her return.

The second major developmental aspect that Noah confronts during this period of early adulthood, is intimacy and the readiness for marriage.  Noah is willing to experience an intimacy with Martha Shaw in order to cope with his loneliness, but avoids having a real relationship with her.  Martha asks Noah to go on what would be consider dates, but he has an excuse not to do most of the activities and eventually just says not.  Noah has no desire to marry or have a true relationship with anyone but Allie.  Though most people in this period would be experiencing a readiness for marriage, Noah instead avoids relationships, but does use intimacy as a coping mechanism.

In a different developmental period, elderhood, Allie experiences dementia which greatly affects her everyday life.  Allie’s dementia is as a result to Alzheimer’s disease, and she has lost her memories of the past.  Allie does not remember that the man reading to her is her husband and she does not remember her children when they come to visit.  Due to Allie’s Alzheimer’s disease, it leads to another developmental aspect which is living arrangements in old age.  Due to Alzheimer’s, routine can be key to making this comfortable as they the disease progresses in their brain.  Family members are given the decision to be caregivers at home or to institutionalize them.  Allie’s family chose to put her in an institution where she could be cared for by other people, but with this Noah also choose to go to the nursing center with her so he could still somewhat care for her.  Within the institutionalized home, Allie could receive the care she needed from doctors and nurses without the burden being specifically on her husband and children.

Though there are other developmental periods for both characters as well as several other developmental aspects within these periods, these periods for these characters highly exemplify psychological development within a particular person.  Noah’s character further developed with the addition of the other periods of his life in the movie, but this is the period that most highly exemplifies the psychological part of his personality.  Similarly, Allie also shows development in her character over the year, but due to her development of Alzheimer’s, there is a very big psychological development.  Though Noah coped very poorly with his developmental aspects of early adulthood, with the help of her family, Allie was able to cope very well with elderhood.

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Schizophrenia

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  1. Symptoms: changes in the way a person thinks, feels, and relates to other people and the outside environment; no single symptom or specific set of symptoms is a characteristic of schizophrenic patient; problems with their own subjective satisfaction and their ability to complete an education, hold a job, and develop social relationships with other people; about 10% of schizophrenic patients commit suicide; first episode is usually between the ages of 15 and 35, and rarely after 55; fluctuate in severity over time
    1. Prodromal phase: obvious deterioration in role functioning as a student, employee, or homemaker; peculiar behavior, unusual perceptual experiences, outbursts of anger, increased tension, and restlessness; social withdraw, indecisiveness, and lack of will power
    2. Active phase: hallucinations, delusions, and disorganized speech
    3. Residual phase: dramatic symptoms have improved; impoverished expression of emotions
    4. Positive symptoms: hallucinations (sensory experiences that are not caused by actual external stimuli), delusional beliefs (false beliefs based on incorrect inferences about reality)
    5. Negative symptoms: flattening or restrictions of the person’s nonverbal display of emotions (diminished emotional expression/blunted affect); fail to exhibit signs of emotions or feeling; neither happy nor sad; appear to be completely indifferent to their surroundings; voices lack the typical fluctuations in volume and pitch; events in the environment hold little consequence; lack of concern for themselves and for others; anhedonia (inability to experience pleasure); loss of interest in recreational activities and social relationships; unable to experience pleasure from physical sensations (such as taste and touch); malfunction of interpersonal relationships; social withdraw; indecisiveness, ambivalence, and loss of willpower (avolition); algoia (speech disturbance)
    6. Disorganization: thinking disturbances; disorganized speech; making irrelevant responses to questions, expressing disconnected ideas, using words in peculiar ways; shifting topics too abruptly (loose association/derailment); responding to a questions with an irrelevant response (tangetiality); persistently repeating the sae word or phrase over and over again (preservation); catatonic behavior (obvious reduction in reactivity to external stimuli); exhibit reduced or awkward spontaneous movements; unusual postures or remain in a rigid standing or sitting positions for long periods of time; resist attempts to alter position; stuperous state (generally reduced responsiveness); inappropriate affect (incongruity and lack of adaptability in emotional expression)
  2. Diagnosis: subtypes: 3 types: paranoid, disorganized, catatonic, and undifferentiated
    1. 2 (or more) of the following, each present for a significant portion of time during a 1-month period (or less if successfully treated). At least 1 of these must be the first three below
      1. Delusions
      2. Hallucinations
      3. Disorganized speech
      4. Grossly disorganized or catatonic behavior
      5. Negative symptoms
    2. For a significant portion of the time since the onset of the disturbance, level of functioning in one or more major areas, such as work, interpersonal relations, or self-care, is markedly below the level achieved prior to onset
    3. Continuous signs of disturbance persist for at least 6-month. This 6-month period must include at least 1-month of symptoms that meet criterion A and may include periods of prodromal or residual symptoms.  During these prodromal or residual, the signs of the disturbance may be manifested by only negative symptoms or by two or more symptoms listed in Criterion A present in an attenuated form
    4. Schizoaffective disorder and depressive or bipolar disorder with psychotic features have been ruled out because either 1) no major depressive or manic episodes have occurred concurrently with the active-phase symptoms, or 2) if mood episodes have occurred during active-phase symptoms, they have been present for a minority of the total duration of the active and residual periods of illness
    5. The disturbance is not attributable to the physiological effects of a substance or another medical condition
    6. If there is a history of autism spectrum disorder or a communication disorder of childhood onset, the additional diagnosis of schizophrenia is made only if prominent delusions or hallucinations, in addition to the other required symptoms of schizophrenia, are also present for at least 1-month.
  3. Course and Outcome: deteriorating course of the condition; many patients improve in terms of symptoms; evidence indicates that different dimensions of outcomes (social adjustment, occupational functioning, and symptoms severity are only loosely correlated)
  4. Frequency of Disorder: approximately 1% of people in the US have schizophrenia or other psychotic disorders; men are 30 to 40% more likely to develop schizophrenia than women; men exhibit overt symptoms younger by 4 or 5 years and exhibit more negative symptoms; rates of schizophrenia vary from country to country
  5. Etiology:
    1. Biological Factors: genetics, pregnancy and birth complications (diseases/infections, extended labor, forceps delivery, breech delivery, umbilical cord wrapped around the baby’s neck, dietary factors such as malnutrition), viral infections, neuropathology reflecting the increased and decreased use of different areas of the brain, chemicals in the brain
    2. Social Factors: nutritional variables, stressful life events, social class (amount of hardships, harmful events), immigrants have higher rates of schizophrenia
    3. Psychological Factors: family interactions can have effect on the course of schizophrenia
  6. Treatment(s):
    1. Antipsychotic medications: classical/traditional antipsychotics such as chlorpromazine (Thorazine); atypical antipsychotics such as risperidone (Risperdal), olanzapine (Zyprexa), quetiapine (Seroquel); other medications have been used over the years
    2. Psychosocial Treatment: Family orientated after care, social skills training, cognitive therapy, assertive community treatment, institutional programs
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Dissociative Identity Disorder (DID)

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  1. Symptoms: 2 or more personalities exist between a single individual; persistent and maladaptive disruptions of memory, consciousness, or identity; may produce amnesia, confused travel of long distances
  2. Diagnosis: 2 or more personalities repeatedly take control of a person’s behavior, with alternations in mood, behavior, and at least some loss of recall between the personalities
  3. Course and Outcome: effectiveness of treatment is not known nor is the outcome due to lack of research
  4. Frequency of Disorder: amount of cases of DID shot from 200 to 40,000 after the release of Sybil; 3% of the general population suffers from DID; while the DSM-5 gives a prevalence rate of 1.5% with the disclaimer that the number is based on a “small study”; DID is rarely diagnosed outside of the USA and Canada
  5. Etiology: response to trauma, though this is skeptical; fragmented sleep-wake cycle, sleep deprivation; iatrogenesis (the manufacture of a disorder by its treatment)
  6. Treatment(s): focus on uncovering and recounting traumatic experiences; goal of integrate the different personalities into a whole; sometimes use antianxiety, antidepressants, and antipsychotic medications
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Erectile Dysfunction

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  1. Symptoms: the vascular reflex mechanism in the penis fails; sufficient blood is not pumped to the penis to make it erect; occurs any time prior to orgasm; some have trouble achieving an erection during sexual foreplay; occurs in one of two ways:
    1. Difficulties in obtaining an erection long enough to accomplish intercourse
    2. Difficulties in maintaining an erection long enough to satisfy themselves and their partners during intercourse
  2. Diagnosis: Symptoms must occur for at least six months and lead to marked distress in the person that experiences them; diagnosis made by experienced therapists who would take into account persons age, the context of a person’s life, and whether the person experienced stimulation that would ordinarily be expected to lead to sustained arousal and orgasm
  3. Course and Outcome: Sexual disorders such as erectile dysfunction are well understood and there are several treatments that good results to cope with the disorder
  4. Frequency of Disorder: in men 18 to 24, 6% reported erectile problems; men 55 to 59, 20% reported erectile problems; erectile problems increase with age, they achieve erection slower, but can maintain it for a longer period of time; older men find it more difficult to regain an erection if lost before orgasm
  5. Etiology:
    1. Biological factors:
      1. Hormonal impairments: Men with inadequate levels of sex hormones (testosterone) have a lower sexual appetite
      2. Vascular impairments: effects the amount of blood reaching the penis
      3. Neurological impairment: epilepsy and multiple sclerosis; lacking spinal reflexes; diabetes
      4. Drugs: cigarettes, alcohol, marijuana
    2. Psychological Factors: beliefs and attitudes towards sexuality; anxiety; negative emotions in the presence of erotic stimuli
  6. Treatment(s):
    1. Psychological procedures: focuses on activities of sensate focus and scheduling, education and cognitive restructuring, and communication training
    2. Biological treatment:
      1. Medications: phosphodiesterase-5 (PDE-5) inhibitors that facilitate an erection by increasing blood flow to certain areas of the penis: Sildenafil citrate (Viagra), tadalafil (Cialis), vardenafil (Levitra)
      2. Surgical: inserting a penile implant (or prosthesis):
        1. semi-rigid silicone rod that the man can bend into position for intercourse
        2. hydraulic that can be inflated for the purpose of sexual activity
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Specific Phobias

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  1. Symptoms: persistent, irrational, and narrowly defined fear of a specific object or situation; complete avoidance of contact with said object or situation
  2. Diagnosis: The object or situation is actively avoided; the fear/anxiety is out of proportion with the actual danger posed by the object or situation; exposure must result in an immediate fear response; avoidance or distress associated with the phobia must interfere significantly with the person’s normal activities or relationships with others
  3. Course and Outcome: long-term outcome for anxiety disorders is mixed and unpredictable though some people do completely recover
  4. Frequency of Disorder: one year prevalence of 9% in adults (most common anxiety disorder); 50% rate of comorbidity rate of an anxiety disorder with another anxiety disorder or a mood disorder; 60% of people with a primary diagnosis of major depression also qualify for an anxiety disorder diagnosis; women have higher rates of relapse than men; women are three times more likely to experience a specific phobia; anxiety disorders are higher in elderly people in their 70s and 80s
  5. Etiology: maladaptive evolutionary anxiety and fears- though some anxiety/fear can be adaptive, it is maladaptive when it becomes excessive, becomes intense at an inappropriate time or place, the response systems become more harmful than helpful; social factors- stressful life events involving danger and interpersonal conflict;  stressful life events- high stress levels; childhood adversity- maternal prenatal stress, multiple maternal partner changes, parental indifference, physical abuse;  attachment relationships and separation anxiety;  learning processes- classical conditioning, such as after a traumatic experience, but can also develop in the absence of an direct experience with the feared object; cognitive factors-perceptions, memories, and attention influence the reaction to the environment;  perception of control- people who feel they are less in control of their environment are more likely to develop an anxiety disorder;  catastrophic misinterpretation- pertaining to bodily activities such as a rapid heart rate; attention to threat and biased information processing; genetic factors;  neurobiology-  response to stimuli by the amygdala
  6. Treatment(s): psychoanalytic psychotherapy;  systematic desensitization- recalling items that cause the least to the most fear for the patient;  interoceptive exposure- going through exercises that result in the same stimuli as when the fear or anxiety appears; relaxation and breathing retraining- tensing and releasing muscles with slow breathing, emphasis of the physiological effects of hyperventilation; cognitive therapy- teaching clients more useful ways of interpreting their environment; medications- benzodiazepines (Valium and Xanax) , azapirones, SSRIs (Prozac, Luvox, Zoloft, Paxil)
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Persistent Depressive Disorder

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Persistent depressive disorder, also known as dysthymia, is a milder form of depression, but the patient is rarely without symptoms.  Symptoms of dysthymia include poor appetite or overeating, insomnia or hypersomnia, low energy or fatigue, low self-esteem, poor concentration or difficulty making decisions, and feelings of hopelessness.  Two or more of these symptoms must be present for the diagnosis of persistent depressive disorders and these symptoms cannot be absent for more than two months during a two year period.  Dysthymia has a lifetime risk of about three percent for the average person in a sample of more than nine thousand people in interviews by the National Comorbidity Survey Replication.

The typical onset for a depressive mood disorder is age thirty-two, but this may vary.  Lengths in depressive episodes vary, but must last at least two weeks and usually have to have at least two episodes.  Episodes may reoccur and may be divided with periods of partial or full recovery.  Half of all depressive patients recover within six months of an episode, and after a full recovery are less likely to relapse as the remission period gets longer.

Risk factors may include stressful life events, how people react to events in society surrounding them, genetic predisposition, hormone imbalances of the endocrine glands, brain structure, and neurotransmitter misfires.

Treatments may include interpersonal therapy focusing on relationships especially with family and antidepressant medication

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Anorexia

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  1. Symptoms: 2 main types are restricting (not engaged in binge eating or purging in the last 3 months) or binge eating/purging type (regular binging and purging)
    1. Classic Symptoms: significantly low weight (a BMI below 18.5; emaciation= 25-30% below regular body weight), distorted view of his/her body, intense fear of gaining weight
    2. Commonly associated symptoms: Amenorrhea (cessation of menstruation), obsessive preoccupation with food, occasional purging, “successful” struggle for control over persistent hunger, struggle for control, act impulsively, conforming and controlling; symptoms of depression (sad mood, irritability, insomnia, social withdraw, diminished interest in sex)
    3. Difficulties associated with Anorexia: mood disturbance; sexual problems; lack of impulse control; medical issues such as: constipation, abdominal pain, intolerance, lethargy, low blood pressure and low body temperature, lanugo (fine, downy hair on face and trunk of the body), anemia, infertility, inpaired kidney functioning, cardiovascular problems, dental erosion, bone loss, electrolyte imbalance leading to cardiac arrest or kidney failure
  2. Diagnosis: Must meet the following 3 criteria:
    1. Restriction of energy intake relative to requirements, leading to significantly low body weight in the context of age, sex, developmental trajectory, and physical health
    2. Intense fear of gaining weight or of becoming fat, or persistent behavior that interferes with weight gain, even though at a significantly low weight
    3. Disturbance in the way in which one’s body weight or shape is experienced, undue influence of body weight r shape on self-evaluation, or persistent lack of recognition of the seriousness of the current low body weight
  3. Course and Outcome: 5% of people with anorexia die of starvation, suicide, or medical complications; at a 10-20 year follow-up nearly half of patients have returned to normal range, 20%  remain significantly below healthy body weight, the remainder are at an intermediate body weight; 5% of patients starve themselves to death or die of related complications including suicide; half of all women with a history of anorexia continue to be preoccupied with diet, weight, and body weight, notwithstanding weight gain;
  4. Frequency of Disorder: females are ten times more likely than males to have an eating disorder; 1995-1996 there were 54 cases per million people; 12 month prevalence of anorexia is .4 among females, similar to .9 estimate based on a recent US survey; difficult to establish prevalence in men
  5. Etiology: Typically in adolescents or early adulthood; caused by hormonal changes. Autonomy struggles, various sexual problems;
    1. Social factors: high standards of beauty for extreme thinness; working in fields that emphasize weight and appearance (models, ballet dancers, gymnasts); in adolescence culture puts an emphasis on appearance, beauty, and thinness; greater exposure to popular media, endorse more gender-role stereotypes, internalize societal standards; white women; industrialized societies; troubled family relationships; enmeshed families (overly involved in each others’ lives; child abuse
    2. Psychological factors: control issues, depression/dysphoria, body image dissatisfaction, reactions to dietary restraints; overly conforming, eager to please; perfectionism; lack of interoceptive awareness; low self-esteem; dietary restraint; weight suppression
    3. Biological factors: gene influence on personality characteristics such as anxiety; certain body types; genetic influence on pathology after puberty; hypothalamus
  6. Treatment(s): family therapy, Maudsley method (parents take complete control over the anorexic child’s eating, planning meals, preparing food, and monitoring food), age appropriate autonomy is returned to the teenager as eating and weight improve; 2 goals:
    1. Help patient gain minimal weight; if too severe they may be hospitalized and receive feeding that is forced or through intravenous methods or participate in a strict behavior therapy program that make rewards contingent on weight gain
    2. Address the broader eating difficulties