Question

1. Classify the different types of medications used in the treatment of mental disorders and explain how they each work to reduce symptoms.
2. List and evaluate Kübler-Ross's five stages of grief (denial, anger, bargaining, depression, acceptance).
3. Define and describe the stages of prenatal development and some factors that can harm a developing fetus during pregnancy.
4. Explain the DSM is and how it defines a psychological disorder.
5. Describe the characteristic symptoms of schizophrenia and describe potential causes of schizophrenia.

Answer 1

1) Psychoactive Drugs

The treatment of mental disorders includes Psychotherapy and Psycho pharmacotherapy. In many mental disorders a combination of both Psychotherapy and Psycho pharmacotherapy is best advised. The medicines or drugs that significantly affect the higher mental functioning of human beings are normally called as psychoactive drugs. The different types of psychoactive drugs used in the treatment of psychiatric disorders can be classified as follows:

• Antidepressants
• Anti-anxiety drugs
• Mood stabilizers
• Anticonvulsant
• Stimulants
• Antipsychotics

Antidepressants

Antidepressants are category of psychoactive drugs mainly used for the treatment and maintenance of depressive disorders. Most of the antidepressants that are commonly used like Fluoxetine and Citalopram are Selective Serotonin Reuptake Inhibitors or SSRIs. Another type of antidepressants which are commonly used is Serotonin and Norepinephrine Reuptake Inhibitors or SNRIs. Other anti depressants include tricyclics, tetracyclics, and monoamine oxidase inhibitors (MAOIs).

Anti-anxiety drugs

Anti-anxiety drugs are usually used to treat anxiety disorders like fear, panic attacks or worry and they work best when combined with psychotherapy like relaxation training. Benzodiazepines are the most common anti-anxiety medications. Benzodiazepines are used to treat generalized anxiety disorder. Most commonly used Benzodiazepines are Lorazepam, Clonazepam and Alprazolam. These medicines help in controlling the physical symptoms of anxiety like such as trembling, rapid heartbeat, and sweating that people with phobias experience while in difficult situation.

Mood stabilizers and Anticonvulsants

These drugs are also known as mood-stabilizing agents as they help in controlling the mood swings caused by bipolar disorder. They are also used in the treatment of mania. The most commonly use medicines are Lithium, Valproate, Carbamazepine and Oxcarbazepine. In some cases anticonvulsant drugs are also used to treat mood disorders. Even though they were originally designed to treat seizures they also help in managing unstable mood.

Stimulants

Stimulants are psychoactive drugs that stimulate brain activity that is, these drugs increase brain activities like alertness, attention, and energy, as well as elevate blood pressure, heart rate, and respiration. These drugs are typically used to treat ADHD is prescribed to children as well as adults. The most common stimulants used are Methylphenidate, Amphetamine and Dextroamphetamine. These drugs calms down or helps in focusing. It increases the capacity to retain attention.

Antipsychotics

Antipsychotic drugs are typically used in the treatment of psychosis. They are mostly used in combination with medicines that treat delirium, dementia, and mental health conditions like depression, Post Traumatic Stress Disorder, Eating disorder etc. An antipsychotic drug do not cure a disease or condition, the simply help in relieving the symptoms. Some of the commonly used antipsychotic drugs are Chlorpromazine, Haloperidol, Perphenazine and Fluphenazine.

2) Kubler-Ross's five stages of grief

Kubler-Ross had a developed a five-stage model about death and dying in 1969. She described five stages of grief in her book “On Death and Dying” These changes represent normal ranges of feelings that individuals experience when faced with changes in their lives, those related to death and grief.

The five stages of grief according to Kubler-Ross are:

1. Denial
2. Anger
3. Bargaining
4. Depression
5. Acceptance

Denial

Denial or shock is the initial stage where we are not ready or prepared to accept the change. It necessarily gives us time to absorb the news of change before directly going to other stages.

Anger

This is the stage where we begin to accept the change and form a reaction to it mostly in the form of anger. We try to look for someone or something to blame for the things happening to us.

Bargaining

In this stage we try our best to postpone change. We ask for more time before the change happens. We start bargaining especially to God, to put off change or find a solution for it.

Depression

In this stage, we realize that our bargain is not going to work and become aware of the losses we need to face as the result of the change. In this stage we feel low energy, a sad state and a ‘feeling down’ state.

Acceptance

In this last stage we realize that every change is not designed to fight back, it is important to stay resigned and learn to move on with it. It is a stage of acceptance and there is opportunity to look for new possibilities in future.

3) Prenatal development

Prenatal maybe explained as the process in which a baby develops from a single cell after conception into an embryo and later a fetus.

The average length of time for development of the foeatus to complete is 38 weeks from the date of conception. During this time, a single-celled zygote develops in a series of stages into a full-term baby. The three primary stages of prenatal development are the germinal stage, the embryonic stage, and the fetal stage.

Germinal stage:

The germinal stage is the two-week period after conception. Conception normally occurs when a sperm cell combines with an egg cell and forms a zygote. About thirty-six hours after conception, the zygote starts to divide quickly. Later, the resulting ball of cells moves along the mother’s fallopian tube to the uterus.

Around almost seven days after conception, the ball of cells starts to become embedded in the wall of the uterus. This process is called implantation and it takes about a week to complete. The pregnancy terminates if implantation fails, as is quite common. One key feature of the germinal stage is the formation of a tissue called the placenta. The placenta has mainly two functions – it passes oxygen and nutrients from the mother’s blood into the embryo or fetus and removes waste materials from the embryo or fetus.

Embryonic stage

The embryonic stage normally lasts from the end of the germinal stage to two months after conception. The developing ball of cells can be now called as an embryo. In this stage, all the major organs begin to form; also, the embryo becomes very fragile. The biggest dangers are teratogens, which are agents such as viruses, drugs, or radiation that can cause deformities in an embryo or fetus. At the end of the embryonic period, the embryo is only about an inch long.

Fetal stage

The last stage of prenatal development maybe called as the fetal stage. It lasts from two months after conception until birth. About one month into this stage, the sex organs of the fetus start to form. The fetus quickly grows as it’s bones and muscles form, and it begins to move inside the uterus. Organ systems develop further and start to function. During the last three months, the brain increases rapidly in size, an insulating layer of fat forms under the skin, and the respiratory and digestive systems start to work independently.

4) Diagnostic and Statistical Manual

DSM is an abbreviation used for the "Diagnostic and Statistical Manual of Mental Disorders," It is a comprehensive manual or a guide that classifies officially recognized psychiatric disorders. It is published by the American Psychiatric Association, to guide mental health professionals as well as to ensure uniformity of diagnosis.

According to DSM-5 "A mental disorder is a syndrome characterized by clinically significant disturbance in an individual's cognition, emotion regulation, or behavior that reflects a dysfunction in the psychological, biological, or developmental processes underlying mental functioning. Mental disorders are usually associated with significant distress in social, occupational, or other important activities. An expectable or culturally approved response to a common stressor or loss, such as the death of a loved one, is not a mental disorder. Socially deviant behavior (e.g., political, religious, or sexual) and conflicts that are primarily between the individual and society are not mental disorders unless the deviance or conflict results from a dysfunction in the individual, as described above."

5) Schizophrenia

Schizophrenia is characterized by disruption in cognition and emotion that significantly affects attributes like language, affect, thought, perception and sense of self.

The symptoms of Schizophrenia maybe characterized into Positive and Negative symptoms. Positive symptoms are those which shows and excess or distortion in the normal functioning. Negative symptoms appear to have a loss in normal functioning.

Positive Symptoms:

• Delusion – a strong unshakable belief which is usually misinterpretation of the reality for example some patients explain that they are ‘being watched or followed’ or ‘somebody is trying to harm’
• Hallucination – it occurs when people start perceiving things without the presence of actual stimuli. Egs, hearing strange voices (Auditory hallucination) or seeing things (Visual hallucination)
• Grossly disorganized behavior – it is when people find it difficult to perform normal daily activities, an unusual silliness or inhibition will be observed.
• Catatonic behaviors – marked decrease in motor activities will be observed and their reaction to surrounding will be decreased. Sometimes they acquire a rigid posture and remain in that same posture for many hours (stupor) or there will be an aimless excess in motor activity.
• Other symptoms – include symptoms like depersonalization, derealization, unusual motor behavior and somatic preoccupations.

Negative symptoms:

• Affective flattening – expression of emotion will be flattened or reduced significantly including facial expression, tone, eye contact and body language.
• Alogia – it means there will be a poverty of speech, productivity of speech will e reduced and it reflects blocking of thoughts
• Avolition – an inability or difficulty to engage in goal-directed behavior. It is often confused with disinterest.

Causes of Schizophrenia

Researchers still do not know the exact causes of schizophrenia. But researches suggests do a combination of physical, genetic, psychological and environmental factors which could make a person more prone to develop the condition.

Some people may be simply prone to schizophrenia, and a stressful or emotional life event might trigger a psychotic episode. However, it's not exactly known why some people develop symptoms of schizophrenia and others don't.

Increased risk

Things that increase the chances of schizophrenia developing include:

Genetics

Studies show that Schizophrenia tends to run in families, but even then no single gene is thought to be responsible.

Studies show that it is more likely that different combinations of genes make people more vulnerable to schizophrenia. However, having these genes does not necessarily mean a person is likely to develop schizophrenia.

Evidence related to the fact that the disorder is partly inherited is known from studies of twins. Identical twins share the same genes.

In identical twins, as studies suggest, if one twin develops schizophrenia, the other twin has a one in two chance of developing it. This is likely to be true even if they are raised in separate condition by separate guardians.

In the case of non-identical twins, who have different genetic make-ups, when one twin develops schizophrenia, the other only has a lesser chance, one in seven chance of developing the condition.

Brain development

Studies of people with schizophrenia have shown there are subtle differences in the structure of their brains.

These changes are not seen in everyone with schizophrenia and can even occur in people who don't have a mental illness. But researches suggest that schizophrenia may partly be a disorder of the brain.

Neurotransmitters

Neurotransmitters are chemicals that carry messages between brain cells.

Studies essentially show that there is a connection between neurotransmitters and schizophrenia because drugs that alter the levels of neurotransmitters in the brain are known to relieve some of the symptoms of schizophrenia.

Research suggests that schizophrenia may be caused by a change in the level of two neurotransmitters namely dopamine and serotonin.

Some studies indicate that an imbalance between serotonin and dopamine in the brain may be the basis of schizophrenia. Others have found a change in the body's sensitivity to the neurotransmitters may be the cause of schizophrenia.

Pregnancy and birth complications

Researches show that people who develop schizophrenia are more likely to have experienced complications before and during their birth, such as:

• a low birth weight
• premature labour
• a lack of oxygen (asphyxia) during birth

It may be true that these things have a subtle effect on development of the brain.

Triggers

Triggers are things that can cause schizophrenia to develop in people who are at risk.

These include:

Stress

The psychological triggers that can cause schizophrenia are stressful life events, such as:

• bereavement
• losing your job or home
• divorce
• the end of a relationship
• physical, sexual or emotional abuse

These kinds of experiences, although stressful, don't cause schizophrenia. However, they can trigger the development of the condition in someone who is vulnerable to it.

Drug abuse

Drugs normally do not directly cause schizophrenia, but studies have shown that drug abuse increases the risk of developing schizophrenia or other mental illness.

Certain drugs, particularly cannabis, cocaine, LSD or amphetamines, may trigger the symptoms of schizophrenia in people who are susceptible to the disease.

Using amphetamines or cocaine can lead to conditions of psychosis, and can cause a relapse in people recovering from an earlier episode of the same.