Schizophrenia, Bipolar Disorder, Nightmare Disorder,Anxiety Disorder

1. Specific disorders
&
Treatment
Instructor : Ms. Amina Rafiq

2. UNiVERSITY OF THE PUNJAB
(GUJRANWALA CAMPUS)
(PUGC)
Batch(2015-19)

3. Specific disorders
&
Treatment
Presenters:
• Mohammad Wajih Ul hassan (BT-15024)
• Usama Javed (BT-15033)
• Umer Hameed (BT-15047)
• Naeem Ali (BT-15027)

4. Schizophrenia

5. Schizophrenia:
“A long-term mental disorder of a type involving ;
 A breakdown in the relation between thought,
emotion, and behavior, leading to faulty perception,
inappropriate actions and feelings
 Withdrawal from reality and personal relationships
into fantasy and delusion
 A sense of mental fragmentation.“

6. What is Schizophrenia?
• Schizophrenia is a serious mental
illness that interferes with a person’s
ability to think clearly, manage
emotions, make decisions and relate
to others. It is a chronic and severe
mental disorder that affects how a
person thinks, feels, and behaves.
People with schizophrenia may
seem like they have lost touch with
reality.

7. What is Schizophrenia?
• Schizophrenia most commonly strikes between the ages of 16 and 30,
and males tend to show symptoms at a slightly younger age than
females.
• In many cases, the disorder develops so slowly that the individual
does not know that they have had it for many years. However, in
other cases, it can strike suddenly and develop quickly.
• Experts say schizophrenia is probably many illnesses masquerading as
one.

8. Fast facts on schizophrenia
• Schizophrenia affects an estimated 1 percent of the population.
• Symptoms include delusions, hallucinations, and disorganized
thoughts.
• Diagnosing schizophrenia comes only after other disease have been
ruled out.

9. Subtypes

10. What Causes Schizophrenia?
The cause of schizophrenia is still unclear. Some theories about the
cause of this disease include:
• Genetics (heredity)
• Biology (abnormalities in the brain’s chemistry)
• Environmental factors
• Drugs

11. Genetics (Heredity)
• Scientists recognize that the disorder tends to run in families and that
a person inherits a tendency to develop the disease. Similar to some
other genetically-related diseases, schizophrenia may appear when
the body undergoes hormonal and physical changes.
• If there is no history of schizophrenia in a family, the chances of
developing it are less than 1 percent. However, that risk rises to 10
percent if a parent was diagnosed.

12. Biology
• Chemistry - Scientists believe that people with schizophrenia have an
imbalance of the brain chemicals or neurotransmitters: dopamine,
glutamate and serotonin. These neurotransmitters allow nerve cells in
the brain to send messages to each other. The imbalance of these
chemicals affects the way a person’s brain reacts to stimuli--which
explains why a person with schizophrenia may be overwhelmed by
sensory information (loud music or bright lights) which other people
can easily handle. This problem in processing different sounds, sights,
smells and tastes can also lead to hallucinations or delusions.

13. Environmental factors
• Stressful experiences often precede the emergence of schizophrenia.
Before any acute symptoms are apparent, people with schizophrenia
habitually become bad-tempered, anxious, and unfocused. This can
trigger relationship problems, divorce, and unemployment.
• These factors are often blamed for the onset of the disease, when
really it was the other way round - the disease caused the crisis.
Therefore, it is extremely difficult to know whether schizophrenia
caused certain stresses or occurred as a result of them.

14. Drug induced schizophrenia
• Marijuana and LSD are known to cause schizophrenia relapses.
Additionally, for people with a predisposition to a psychotic illness
such as schizophrenia, usage of cannabis may trigger the first
episode.
• Some researchers believe that certain prescription drugs, such as
steroids and stimulants, can cause psychosis.

15. Signs and Symptoms
• A sizable proportion of people with schizophrenia have to rely on others
because they are unable to hold a job or care for themselves.
• Many may also resist treatment, arguing that there is nothing wrong with
them.
• Some patients may present clear symptoms, but on other occasions, they
may seem fine until they start explaining what they are truly thinking.
• The effects of schizophrenia reach far beyond the patient - families, friends,
and society are affected too.
• Symptoms and signs of schizophrenia will vary, depending on the
individual.

16. Signs and Symptoms
• The symptoms are classified into four categories:
• Positive symptoms - also known as psychotic symptoms. For example,
delusions and hallucinations.
• Negative symptoms - these refer to elements that are taken away from the
individual. For example, absence of facial expressions or lack of motivation.
• Cognitive symptoms - these affect the person's thought processes. They
may be positive or negative symptoms, for example, poor concentration is
a negative symptom.
• Emotional symptoms - these are usually negative symptoms, such as
blunted emotions.

17. Signs and Symptoms
• Below is a list of the major symptoms:
• Delusions - the patient displays false
beliefs, which can take many forms. They
may feel others are attempting to control
them remotely. Or, they may think they
have extraordinary powers and abilities.
• Hallucinations - hearing voices is much
more common than seeing, feeling,
tasting, or smelling things which are not
there, however, people with
schizophrenia may experience a wide
range of hallucinations.
• Thought disorder - the person may jump
from one subject to another for no logical
reason.

18. Signs and Symptoms
• Other symptoms may include:
• Lack of motivation (Avolition) - the patient loses their drive. Everyday actions, such as
washing and cooking, are neglected.
• Poor expression of emotions - responses to happy or sad occasions may be lacking, or
inappropriate.
• Social withdrawal - when a patient with schizophrenia withdraws socially, it is often
because they believe somebody is going to harm them.
• Unawareness of illness - as the hallucinations and delusions seem so real for patients,
many of them may not believe they are ill. They may refuse to take medication for fear of
side effects, or for fear that the medication may be poison, for example.
• Cognitive difficulties - the patient's ability to concentrate, recall things, plan ahead, and
to organize their life are affected. Communication becomes more difficult.

19. • Dr. John Forbes Nash

20. Treatment
• Up to 3 in 10 people with schizophrenia may have a lasting recovery,
and 1 in 5 people may show significant improvement. Around half of
people diagnosed with schizophrenia will continue to have it as a
long-term illness. Everyone’s experience of schizophrenia is different.
It may get better then worse, involve further episodes of being
unwell, or may be more constant.
• Because the causes of schizophrenia are still unknown, treatments
focus on eliminating the symptoms of the disease. Treatments
include:

21. Treatment
• Antipsychotics
• Psychosocial Treatments
• Coordinated specialty care (CSC)

22. How can I help someone I know with
schizophrenia?
• Here are some things you can do to help your loved one:
• Get them treatment and encourage them to stay in treatment
• Remember that their beliefs or hallucinations seem very real to them
• Tell them that you acknowledge that everyone has the right to see things
their own way
• Be respectful, supportive, and kind without tolerating dangerous or
inappropriate behavior
• Check to see if there are any support groups in your area

23. Any Question?

24. Bipolar Disorder

25. Bipolar Disorder:
• Bipolar disorder, also known as manic depression, is a mental illness that
brings severe high and low moods and changes in sleep, energy, thinking,
and behavior. It's also known as manic depression or manic depressive
disorder.
• People who have bipolar disorder can have periods in which they feel
overly happy and energized and other periods of feeling very sad, hopeless,
and sluggish. In between those periods, they usually feel normal. You can
think of the highs and the lows as two "poles" of mood, which is why it's
called "bipolar" disorder.

26. Types of Bipolar Disorder:
There are four basic types of bipolar disorder:
• Bipolar I Disorder
• Bipolar II Disorder

27. Cyclothymic Disorder :
• Defined by numerous periods of hypomanic symptoms as well
numerous periods of depressive symptoms. However, the symptoms
do not meet the diagnostic requirements for a hypomanic episode
and a depressive episode.

28. Mania:
• The word "manic" describes the times when someone with bipolar disorder feels
overly excited and confident. These feelings can also involve reckless decision-
making. About half of people during mania can also have delusions (believing
things that aren't true and that they can't be talked out of) or hallucinations
(seeing or hearing things that aren't there).
• A manic episode is more than just a feeling, high energy, or being distracted.
During a manic episode, the mania is so intense that it can interfere with your
daily activities. It’s difficult to redirect someone in a manic episode toward a
calmer, more reasonable state. People who are in the manic phase of bipolar
disorder can make some very irrational decisions, such as spending large amounts
of money that they can’t afford to spend.
• An episode can’t be officially deemed manic if it’s caused by outside influences.
This includes alcohol, drugs, or another health condition.

29. Hypomania:
"Hypomania" describes milder symptoms of mania, in which someone
does not have delusions or hallucinations, and their high symptoms do
not interfere with their everyday life. A hypomanic episode is a period
of mania that’s less severe than a full-blown manic episode. Though
less severe than a manic episode, a hypomanic phase is still an event in
which your behavior differs from your normal state. The differences will
be extreme enough that people around you may notice that something
is wrong.

30. What Are the Symptoms of Bipolar Disorder?
• In bipolar disorder, the dramatic episodes of high and low moods do
not follow a set pattern. Someone may feel the same mood state
(depressed or manic) several times before switching to the opposite
mood. These episodes can happen over a period of weeks, months,
and sometimes even years.
• How severe it gets differs from person to person and can also change
over time, becoming more or less severe. The highs are known as
manic episodes. The lows are known as depressive episodes.

31. Bipolar 1:“Highs":
• Excessive happiness, hopefulness, and excitement
• Sudden changes from being joyful to being irritable, angry, and hostile
• Restlessness
• Rapid speech and poor concentration
• Increased energy and less need for sleep
• Making grand and unrealistic plans
• Showing poor judgment
• Drug and alcohol abuse

32. Bipolar 2:Lows:
• Sadness
• Loss of energy
• Feelings of hopelessness or worthlessness
• Not enjoying things they once liked
• Trouble concentrating
• Uncontrollable crying
• Trouble making decisions
• Needing more sleep

33. Causes:
The exact cause of bipolar disorder is unknown, but several factors may be
involved, such as:
• Biological differences:
• People with bipolar disorder appear to have physical changes in their
brains. The significance of these changes is still uncertain but may
eventually help pinpoint causes.
• Genetics:
• Bipolar disorder is more common in people who have a first-degree
relative, such as a sibling or parent, with the condition. Researchers are
trying to find genes that may be involved in causing bipolar disorder.

34. Risk factors:
Factors that may increase the risk of developing bipolar disorder or act
as a trigger for the first episode include:
• Having a first-degree relative, such as a parent or sibling, with bipolar
disorder
• Periods of high stress, such as the death of a loved one or other
traumatic event
• Excessive usage drug or alcohol.

35. Complications:
Left untreated, bipolar disorder can result in serious problems that
affect every area of your life, such as:
• Suicide or suicide attempts
• Legal or financial problems
• Damaged relationships
• Poor work or school performance

36. Co-occurring conditions:
• If you have bipolar disorder, you may also have another health
condition that needs to be treated along with bipolar disorder. Some
conditions can worsen bipolar disorder symptoms or make treatment
less successful.

37. Anxiety disorders:
• Group of mental disorders characterized by significant feelings of
anxiety and fear. Anxiety is a worry about future events and fear is a
reaction to current events. These feelings may cause physical
symptoms, such as a fast heart rate and shakiness.

38. Eating disorders:
• An eating disorder is a mental disorder defined by abnormal eating
habits that negatively affect a person's physical or mental health.
They include binge eating disorder where people eat a large amount
in a short period of time, 2nd where people eat very little and thus
have a low body weight, 3rd where people eat a lot and then try to rid
themselves of the food.

39. Attention-deficit/hyperactivity disorder
(ADHD):
• ADHD is a disorder that makes it difficult for a person to pay attention
and control impulsive behaviors. He or she may also be restless and
almost constantly active.

40. • Diagnosis:
To determine if you have bipolar disorder, your evaluation may include:
• Physical exam:
Your doctor may do a physical exam and lab tests to identify any medical
problems that could be causing your symptoms.
• Psychiatric assessment:
Your doctor may refer you to a psychiatrist, who will talk to you about your
thoughts, feelings and behavior patterns. You may also fill out a psychological
self-assessment or questionnaire. With your permission, family members or
close friends may be asked to provide information about your symptoms.

41. • Mood charting:
You may be asked to keep a daily record of your moods, sleep patterns
or other factors that could help with diagnosis and finding the right
treatment.
• Criteria for bipolar disorder:
Your psychiatrist may compare your symptoms with the criteria for
bipolar and related disorders in the Diagnostic and Statistical Manual
of Mental Disorders (DSM-5), published by the American Psychiatric
Association.

42. Medications:
A number of medications are used to treat bipolar disorder. The types
and doses of medications prescribed are based on your particular
symptoms.
Medications may include:
• Mood stabilizers:
You'll typically need mood-stabilizing medication to control manic or
hypomanic episodes.

43. Medications:
• Anti-depressants:
Your doctor may add an antidepressant to help manage depression.
Because an antidepressant can sometimes trigger a manic episode, it's
usually prescribed along with a mood stabilizer.

44. Diagnosis in children:
• Although diagnosis of children and teenagers with bipolar disorder
includes the same criteria that are used for adults, symptoms in
children and teens often have different patterns and may not fit
neatly into the diagnostic categories.
• Also, children who have bipolar disorder are frequently also
diagnosed with other mental health conditions such as attention-
deficit/hyperactivity disorder (ADHD) or behavior problems, which
can make diagnosis more complicated. Referral to a child psychiatrist
with experience in bipolar disorder is recommended.

45. Women With Bipolar Disorder:
• Bipolar disorder occurs with similar frequency in men and women.
But there are some differences between the genders in the way the
condition is experienced. For example, a woman is likely to have more
symptoms of depression than mania.
Famous People with Bipolar Disorder of our generation includes Demi
Lovato.

46. Any Question?

47. Nightmare Disorder

48. Nightmare Disorder:
• Overview:
A nightmare is a disturbing dream associated with negative feelings, such as anxiety
or fear that awakens you. Nightmares are common in children, but can happen at
any age, and occasional nightmares usually are nothing to worry about.
Nightmares may begin in children between 3 and 6 years old and tend to decrease
after the age of 10. Although nightmares are common, nightmare disorder is
relatively rare. Nightmare disorder is when nightmares happen often, cause distress,
disrupt sleep, cause problems with daytime functioning or create fear of going to
sleep.

49. Fact:
• A researcher from the University of the West of England was inspired
by her own nightmares and a chance encounter at a lecture to
examine more closely the stuff that dreams are made of. Her PhD
study has focused on an astounding discovery that women suffer
more nightmares then men.

50. Signs & Symptoms:
• You're more likely to have a nightmare in the second half of your night.
Nightmares may occur rarely or more frequently, even several times a
night. Episodes are generally brief, but they cause you to awaken, and
returning to sleep can be difficult.
• Your dream seems vivid and real and is very upsetting, often becoming
more disturbing as the dream unfolds.
• Your dream storyline is usually related to threats to safety or survival, but it
can have other disturbing themes.
• Your dream awakens you.
• You feel scared, anxious, angry, sad or disgusted as a result of your dream.

51. Signs & Symptoms:
• You feel sweaty or have a pounding heartbeat while in bed.
• You can think clearly upon awakening and can recall details of your
dream.
• Your dream causes distress that keeps you from falling back to sleep
easily.

52. Causes:
Nightmares can be triggered by many factors, including:
• Stress or anxiety:
Sometimes the ordinary stresses of daily life, such as a problem at
home or school, trigger nightmares. A major change, such as a move or
the death of a loved one, can have the same effect. Experiencing
anxiety is associated with a greater risk of nightmares.

53. Causes:
• Trauma:
Nightmares are common after an accident, injury, physical or other
traumatic event. Nightmares are common in people who have stress
disorder.
• Sleeping pattern:
Changes in your schedule that cause irregular sleeping and waking
times or that interrupt or reduce the amount of sleep can increase your
risk of having nightmares.

54. Causes:
• Medications:
Some drugs — including certain antidepressants, blood pressure
medications and drugs used to help stop smoking — can trigger
nightmares.

55. Problems regarding Frequent occurrences:
• Major distress or impairment during the day, such as anxiety or
persistent fear, or bedtime anxiety about having another nightmare
• Problems with concentration or memory, or you can't stop thinking
about images from your dreams
• Daytime sleepiness, fatigue or low energy
• Problems functioning at work or school or in social situations
• Behavior problems related to bedtime or fear of the dark
• Having a child with nightmare disorder can cause significant sleep
disturbance and distress for parents or caregivers.

56. When to see a doctor:
Occasional nightmares aren't usually a cause for concern. If your child has
nightmares, you can simply mention them at a routine well-child exam. However,
consult your doctor if nightmares:
• Occur frequently and persist over time
• Routinely disrupt sleep
• Cause fear of going to sleep
• Cause daytime behavior problems or difficulty functioning

57. Treatment:
Treatment for nightmares isn't usually necessary. However, treatment may be
needed if the nightmares are causing you distress or sleep disturbance and
interfering with your daytime functioning.
Treatment options may include:
• Stress or anxiety treatment:
If a mental health condition, such as stress or anxiety, seems to be
contributing to the nightmares, your doctor may suggest stress-
reduction techniques, counseling or therapy with a mental health
professional.

58. Treatment:
• Imagery rehearsal therapy:
Often used with people who have nightmares disorder, imagery
rehearsal therapy involves changing the ending to your remembered
nightmare while awake so that it's no longer threatening. You then
rehearse the new ending in your mind. This approach may reduce the
frequency of nightmares.

59. Treatment:
• Medication:
Medication is rarely used to treat nightmares. However, medication
may be recommended for severe nightmares associated with stress
disorder.

60. Complications:
• Nightmare disorder may cause:
• Excessive daytime sleepiness, which can lead to difficulties at school
or work, or problems with everyday tasks, such as driving and
concentrating on work.
• Problems with mood, such as depression or anxiety from dreams that
continue to bother you
• Suicidal thoughts or suicide attempts

61. Any Question?

62. Anxiety Disorder

63. Anxiety Disorder:
• Overview:
Occasional anxiety is a normal part of life. You might feel
anxious when faced with a problem at work, before taking a test, or
making an important decision. But anxiety disorders involve more than
temporary worry or fear. For a person with an anxiety disorder, the
anxiety does not go away and can get worse over time. The feelings can
interfere with daily activities such as job performance, school work,
and relationships.

64. Definition:
• A feeling of worry, nervousness, or unease about something
with an uncertain outcome.
On the other hand,
Anxiety Disorder causes unexpected or unhelpful anxiety that
seriously impacts our lives, including how we think, feel, and
act.

65. Causes:
• Anxiety may be caused by a mental condition, a
physical condition, the effects of drugs, or a
combination of these. The doctor's initial task is to see
if your anxiety is caused by a medical condition.

66. Common External Factors:
These common external factors are:
• Stress at work
• Stress in a personal relationship such as marriage
• Financial stress
• Stress from a serious medical illness
• Side effect of medication

67. Types of Anxiety Disorder:
Types are:
• Generalized Anxiety Disorder (GAD)
• Panic Disorder
• social phobia (or social anxiety disorder)

68. Generalized Anxiety Disorder (GAD)
Occasional anxiety is a normal part of life. You might worry
about things like health, money, or family problems. But
people with generalized anxiety disorder (GAD) feel
extremely worried or feel nervous about these and other
things—even when there is little or no reason to worry about
them. People with GAD find it difficult to control their anxiety
and stay focused on daily tasks.

69. • According to a research:
• In Pakistan, the average total prevalence of depression
and anxiety established on public samples is 33.62%,
with a point prevalence of 45.5% amongst females and
21.7% amongst males.
• An estimated 40 million American adults suffer from
anxiety disorders.
• anxiety disorders affect approximately 12% of
Canadians: about 9% of men and 16% of women during
a one-year period.

70. Symptoms:
• Restlessness
• Being easily fatigued
• Difficulty concentrating or having their minds go blank
• Irritability
• Muscle tension
• Difficulty controlling the worry
• Sleep problems (difficulty falling or staying asleep or restless,
unsatisfying sleep)

71. Panic Disorder:
• People with panic disorder have recurrent unexpected panic
attacks, which are sudden periods of intense fear that may
include palpitations, pounding heart, or accelerated heart
rate; sweating; trembling or shaking; sensations of shortness
of breath.

72. Symptoms:
• Sudden overwhelming fear
• Palpitations( heart is beating too hard or too fast)
• Sweating
• Shortness of breath
• Sense of choking
• Chest pain
• Nausea
• Dizziness
• Fear of dying
• Chills or hot flushes

73. FAMOUS PEOPLE WITH ANXIETY OR PANIC
DISORDER:
• Abraham Lincoln.
• Johnny Depp.
• Emma Stone.
• Scarlet Johanson.
• Adele.

74. Social Anxiety Disorder:
People with social anxiety disorder (sometimes called “social phobia”)
have a marked fear of social or performance situations in which they
expect to feel embarrassed, judged, rejected, or fearful of offending
others.

75. When Does It Happen?
• Talking to strangers
• Speaking in public
• Making eye contact
• Entering rooms
• Using public restrooms
• Going to parties
• Eating in front of other people
• Going to school or work
• Starting conversations

76. What Does It Feel Like?
• Rapid heartbeat
• Muscle tension
• Dizziness
• Stomach trouble and Diarrhea
• Inability to catch breath

78. Treatment:
• First, talk to your doctor about your symptoms. Your doctor should do an
exam and ask you about your health history to make sure that an unrelated
physical problem is not causing your symptoms. Your doctor may refer to
you a mental health specialist, such as a psychiatrist or psychologist. GAD is
generally treated with psychotherapy, medication, or both. Talk with your
doctor about the best treatment for you.
• Psychotherapy:
• A type of psychotherapy called cognitive behavioral therapy (CBT) is
especially useful for treating GAD. CBT teaches a person different ways of
thinking, behaving, and reacting to situations that help him or her feel less
anxious and worried.

79. Antidepressants
• Antidepressants are used to treat depression, but they also are
helpful for treating anxiety disorders. They take several weeks to start
working and may cause side effects such as headache, nausea, or
difficulty sleeping. The side effects are usually not a problem for most
people, especially if the dose starts off low and is increased slowly
over time

80. Anti-Anxiety Medications
• Anti-anxiety medications help reduce the symptoms of
anxiety, panic attacks, or extreme fear and worry. The most
common anti-anxiety medications are called
Benzodiazepines. Benzodiazepines are first-line treatments
for generalized anxiety disorder. With panic disorder or social
phobia (social anxiety disorder), benzodiazepines are usually
second-line treatments, behind antidepressants.

81. Beta-Blockers:
• Beta-blockers, such as propranolol and atenolol, are also
helpful in the treatment of the physical symptoms of anxiety,
especially social anxiety. Physicians prescribe them to control
rapid heartbeat, shaking, trembling, and blushing in anxious
situations

82. Self-Help or Support Groups:
• Some people with anxiety disorders might benefit from joining a self-
help or support group and sharing their problems and achievements
with others.
• Stay busy working On things which involves
(Creativity,Planning,Focus)
“Emotions and actions are directly connected to each other”

83. Three Steps Technique:
step 1:
• Analyse The Situation Fearlessly and honestly and figure out what is
the worst that could possibly happen.
step 2:
• Mentally Accept the worst possible outcome.
step 3:
• Try to improve the worst which you have already accepted.

84. Any Question?