This presentation was given to first year pharmacy students as part of a course on medical physiology and pathophysiology.

1. Introduction to Neurological &
Psychiatric Disorders
Brian J. Piper, Ph.D., M.S.
October 16, 2012

2. Learning objectives
Pharmacy students should be able to:
1. Compare and contrast psychiatry & neurology
(historical figures & diagnostic systems).
2. Provide examples of animal models of human
neurobehavioral conditions.
3. Evaluate evidence of neurobiological substrates of
psychiatric conditions.

3. Neurology Psychiatry
founder Jean Martin Charcot Philippe Pinel
diagnostic system International Diagnostic &
Classification Statistical
of Diseases (ICD) Manual (DSM)
examples epilepsy, migraine, MS/ALS, depression, schizophrenia,
Parkinson’s sleep, dementia, autism
pathophysiology moderate low
laboratory tests common uncommon
development of moderate moderate
animal models (Parkinson’s, migraine) (drug addiction, schiz)

4. Father of Psychiatry: Philippe Pinel
• moral treatment
• classification: 4
Tony Robert-fleury (1876 ): Philippe Pinel releasing
1745 - 1826 lunatics from their chains at the Salpetriere
asylum for women in Paris.

5. Father of Neurology: Jean Charcot
• Described:
– ALS
– Multiple Sclerosis
– Parkinson’s Disease
– Huntington’s disease
– Tourette syndrome

6. International Classification of Diseases
• UN/WHO
• International List of Causes of Death 1: 1900
• International Statistical Classification of Diseases 6: 1949
• ICD-10: 1994
• ICD-11: 2015
http://www.who.int/classifications/icd/en/HistoryOfICD.pdf

7. Diagnostic & Statistical
Manual of Mental
Disorders (DSM)
• Published by American Psychiatric Association
• DSM-I: 1952: consists of 106 mental disorders
• DSM-II: 1968: psychodynamic
• DSM-III: 1980: descriptive, removal of homosexuality
• DSM-IV: 1994: 297 disorders
• DSM-5: 2013: ≈300 disorders!

8. Major Depressive Disorder
• At least one: • At least five:
– sad mood – ↑/↓sleeping
– anhedonia – psychomotor
agitation/retardation
– loss of energy
– weight loss
– excessive guilt
• Symptoms are present – thoughts of
nearly every day for at death/suicide
least 2 weeks.
Kring et al. (2012). Abnormal Psychology, p. 134.

10. Criticisms of DSM
• economic conflicts of interest
• too subjective (interview, not laboratory based)
• qualitative or quantitative
• comorbidity (anxiety/depression; anorexia/bulimia)
• reliable
• valid
– out: Asperger’s, Catatonic Schizophrenia
– in: Premenstrual Dysphoric Disorder

11. Rosenhan Study
• 8 pseudopatients show up at psychiatric
facilities (12) with one symptom (hearing
voices)
• all diagnosed with schizophrenia
• institutionalized for 7 -52 days
• patients, but not staff, were suspicious
Rosenhan, D. L. (1973). On being sane in insane places. Science, 179, 250-258.

12. Accuracy of Diagnosis
Decision • 8 healthy pseduo-patients presented to
SCZ- SCZ+ 12 psychiatric hospitals with complaint
SCZ- Correct Type I of hearing voices
Reality
Diagnosis error • Acted normal but 11 diagnosed as
schizophrenic
SCZ+ Type II Correct
error Diagnosis • Fellow patients, but not staff, were
suspicious
• Released after 7-52 days (mean = 19)
1929-2012
Rosenhan (1973). Science, 179, 250-258.

13. Neuropsychopharmacology

14. Genain Sisters
“Genain”: Greek “dire birth”, born 1930, all
hospitalized for schizophrenia by early 20s, probability
= 1.5 billion
Nora: intermediate (jobs, no family)
Iris: intermediate (jobs, no family)
Myra: secretary, married, 2 sons
Hester: showed signs at age 11, institutionalized
Genetics: identical
Environment: identical (schizophrenic mom)
Prenatal: ?

15. Genetics & Schizophrenia
The likelihood of an individual suffering from
schizophrenia is 50% if their identical twin has
the disorder.
0 10 20 30 40 50
Identical
Both parents
Fraternal
One parent
Sibling
Nephew or niece
Unrelated

16. Genetics & Schizophrenia
The following shows the prevalence of
schizophrenia in identical twins as seen in
different countries.

17. Heritability of
Psychiatric Disorders
British Medical Journal 1999; 319 : 37

18. Structural Changes & Depression
• Rat research indicate that persistent increases in cortisol are toxic to hippocampal
neurons.
• Studies examining the volume of the hippocampus in MDD were inconsistent.
• A meta-analysis showed that the left (-4.5%) and right hippocampus (-4.0%)
showed reductions.
Cole et al. (2011). Journal of Affective Disorders, 134, 483-487.

19. Brain Morphology & Schizophrenia
Some schizophrenia patients exhibit
morphological changes in the brain like
enlargement of fluid-filled ventricles.
Both Photos: Courtesy of Daniel R. Weinberger, M.D., NIH-NIMH/ NSC

20. Individual Differences in SCZ

21. Meta-Analysis
• 58 studies Region (Left or Right) % of Control
• 1,588 SCZ patients L Lateral Ventricle 130
R Lateral Ventricle 120
Gray Matter 96
White Matter 98
L Frontal Lobe 95
L Hippocampus 95
L Amygdala 91
L Thalamus 96
R Thalamus 96
Wright et al. (2000). American Journal of Psychiatry, 157, 16-25.

22. Concern: Cause or Correlate?
• Adult monkeys received
typical (haloperidol) or *
atypical (olanzapine) *
antipsychotics for 2
years at doses similar to
schizophrenics.
• Gray matter in parietal
cortex was examined.
Konopaske et al. (2007). Neuropsychopharmacology, 32, 1216-1223.

23. Wisconsin Card Sorting Test
• Developed by Esta Berg in
1950s
• Measures cognitive flexibility
and perseverative behaviors
(number, color, shape)

24. Hypofrontality During WCST

25. Example Animal Models
• Psychiatry: Forced Swim Test (depression)
http://www.youtube.com/watch?v=Wq2dyNIL
b5U
• Neurology: Roto-rod (PD/motor function)
http://www.youtube.com/watch?v=xNCWkA3
XlBQ

26. Current: Mental Health “Care”
U.S. Patients in Psychiatric Hospitals, by year.
U.S. Census, 2007.