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🧠 SCHIZOPHRENIA (Dr. Hoan)

What is it?

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What does it look like?

🔴 Positive Symptoms (extra things that shouldn't be there)

• Delusions – False beliefs (e.g., believing you're being controlled, or that you have superpowers)
• Hallucinations – Hearing voices that comment on your actions or talk to each other
• Disorganized speech – Jumping between unrelated ideas, making no sense

🔵 Negative Symptoms (normal things that go missing)

• Flat emotions – Little or no emotional expression
• Apathy – No motivation, stops caring about work, hygiene, relationships
• Social withdrawal – Pulls away from family and friends

🟡 Behavioral Symptoms

• Bizarre behavior (e.g., laughing for no reason, talking to themselves)
• Catatonia – Being frozen/stiff, or in a stupor
• Autism – Getting lost in their own inner world, detaching from reality

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How is it diagnosed?

• ICD-10: At least 1 month of symptoms from the key groups (delusions, hallucinations, disorganized thinking, negative symptoms)
• DSM-5: At least 2 symptoms for 1 month, with functional decline for 6 months total

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What causes it?

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Treatment

• Old generation: Haloperidol, Chlorpromazine
• New generation (fewer side effects): Risperidone, Olanzapine, Quetiapine, Aripiprazole, Clozapine
• Third generation (for negative symptoms): Cariprazine

• Behavioral therapy (reward positive behaviors)
• Group therapy (reduce isolation)
• Family therapy (reduce relapses)
• Rehabilitation (slowly rebuild daily life skills)

• Used when medication doesn't work, or when there's persistent suicidal ideation

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🌊 BIPOLAR DISORDER (Dr. Tam)

What is it?

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The Two Poles

🔴 MANIC Episode (The "High")

• Grandiosity – Feeling special, superior, invincible
• Less sleep – Feels rested after only 3 hours
• Talks more – Can't stop talking
• Racing thoughts – Mind jumping from topic to topic
• Easily distracted
• More activity – Social, work, sexual, all turned up
• Risky behavior – Reckless spending, bad investments, unprotected sex

🔵 DEPRESSIVE Episode (The "Low")

• Persistent sadness
• Loss of interest in everything
• Fatigue and weakness
• Sleep and appetite disruption
• Feelings of guilt, worthlessness
• Thoughts of death or suicide

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Types of Bipolar Disorder

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What causes it?

• Genetics: Having a first-degree relative with bipolar = 10× higher risk
• Neurotransmitters: Imbalances in serotonin, dopamine, norepinephrine
• Environment: Childhood trauma, parental loss, chronic stress, emotional conflicts
• Biological rhythms: Disruptions in circadian (sleep-wake) cycles

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Treatment

• Quetiapine, Olanzapine — used in both manic and depressive phases

• SSRIs used cautiously — can trigger mania if used alone; must be paired with mood stabilizers

• Cognitive Behavioral Therapy (CBT)
• Psychoeducation (teach patients to recognize warning signs)
• Family therapy and social support

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Key Difference Between the Two

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🧠 SCHIZOPHRENIA — Simple Explanation

What Is It?

• Affects about 0.3–0.5% of the population
• Usually begins between ages 15–45 (most commonly 18–26)
• Affects men and women equally, but women tend to recover better
• Very rare in children under 10 or adults over 50

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🔑 The Core Problem — "Bleuler's 4 A's"

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📋 Symptoms

🔴 Positive Symptoms (things that appear that shouldn't be there)

• Delusions — False, unshakeable beliefs
  • "Someone is controlling my thoughts"
  • "I can control the weather" / "Aliens are communicating with me"
• Hallucinations — Hearing voices that comment on their actions or argue about them
• Disorganized speech — Sentences that don't connect, random topic jumps
• Catatonia — Freezing in place, holding strange postures, total stupor

🔵 Negative Symptoms (normal things that disappear)

• Apathy — No motivation, stops caring about work, studies, hygiene
• Flat emotions — Barely reacts to anything, face shows no expression
• Social withdrawal — Avoids family, friends, and the outside world
• Poverty of speech — Very little talking, empty answers

🟡 Disorganized / Behavioral Symptoms

• Laughing or talking to themselves for no apparent reason
• Bizarre gestures or behaviors that only they understand
• Sudden aggression or extreme agitation

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📏 How Is It Diagnosed?

ICD-10 (International)

• Thought insertion/broadcasting/withdrawal
• Delusions of control
• Persistent auditory hallucinations
• Disorganized thinking
• Catatonic behavior
• Negative symptoms

DSM-5 (American)

1. Delusions
2. Hallucinations
3. Disorganized speech

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🗂️ Types of Schizophrenia (ICD-10)

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❓ What Causes It?

1. Brain Chemistry

• Dopamine — Too much in some brain areas, too little in others
• Other chemicals involved: serotonin, noradrenaline, GABA, glutamate

2. Brain Structure

• Abnormalities in the prefrontal cortex (thinking/decision-making), basal ganglia, and brain ventricles

3. Genetics — The strongest factor

Genes load the gun — but environment pulls the trigger.

4. Environment & Psychology

• Childhood trauma or abuse
• Severe psychological stress
• Relationship or family conflicts

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🔄 What Does It Look Like Over Time?

1. Early (Prodromal) phase — Gradual withdrawal, dropping grades/work, mild oddness
2. Active phase — Full hallucinations, delusions, disorganized behavior
3. Residual phase — Quieter, but left with flat emotions, low motivation, poor function

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💊 Treatment

1. Antipsychotic Medications

5 Key Rules for Medication:

1. Identify exactly which symptoms you're targeting
2. Reuse what worked before for that patient
3. Give it 4–6 weeks — don't switch too early
4. Avoid combining two antipsychotics unless necessary
5. Use the lowest effective dose for maintenance

2. Psychotherapy

• Behavioral therapy — Reinforce positive behaviors, build social skills
• Group therapy — Reduce isolation, reconnect with reality
• Family/systemic therapy — Reduce relapses by improving home environment
• Rehabilitation — Gradually rebuild self-care, work, and life skills (very important long-term)

3. Electroconvulsive Therapy (ECT)

• Medications don't work (treatment-resistant schizophrenia)
• Persistent suicidal thoughts that won't respond to drugs

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🔍 What Else Could It Be? (Differential Diagnosis)

• Brain/medical disorders causing psychosis (e.g., epilepsy, infections)
• Bipolar disorder (also has psychotic features)
• Brief psychotic disorder (same symptoms but lasts < 1 month)
• Personality disorders
• Autism spectrum disorder

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💡 One-Sentence Summary

Schizophrenia is a chronic brain illness where the mind loses its grip on reality — causing false beliefs, hallucinations, and emotional flatness — that requires lifelong medication, therapy, and support to manage.

🌊 BIPOLAR DISORDER — Simple Explanation

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What Is Mood?

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Part 1: Depression (The "Low" Pole)

What Is It?

Symptoms (need 5 out of 9, lasting at least 2 weeks):

⭐ = at least 1 of these must be present for diagnosis

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How Common Is Depression?

• Lifetime risk: ~10% of people (up to 15%)
• Women are twice as likely as men (ratio 2:1)
• Peak age: 20–40 years old
• Higher risk if: widowed/divorced, family history, recent childbirth, early parental loss

If Left Untreated:

• A single episode lasts ~10 months on average
• 15% attempt suicide — this is a medical emergency
• Most people have an average of 5 episodes in their lifetime
• The more episodes you have, the higher the risk of another:
  • After 1st episode → 50% chance of recurrence
  • After 2nd → 70%
  • After 3rd → 90%

Depression tends to become chronic without proper treatment.

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What Causes Depression?

1. Monoamine theory — Low levels of serotonin, dopamine, and norepinephrine in the brain
   • Think of serotonin as the brain's "feel-good" messenger. When it's low, the mood crashes.
2. Stress theory — Chronic stress damages brain circuits that regulate mood
3. Circadian rhythm disruption — Sleep-wake cycle problems throw mood regulation off

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Treating Depression

• Old generation (TCAs): Imipramine, Amitriptyline, Clomipramine
• New generation (SSRIs) (preferred, fewer side effects): Fluoxetine, Paroxetine, Sertraline, Citalopram, Fluvoxamine
• SNRI: Venlafaxine
• Other: Quetiapine, thyroid hormones (T3/T4), Moclobemide
• Non-drug: Transcranial magnetic stimulation (TMS) — uses magnetic pulses to stimulate brain areas

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Part 2: Bipolar Disorder (Both Poles)

What Is It?

Imagine a pendulum that swings from deep depression to sky-high mania — and the person has little control over it.

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The Manic Episode (The "High" Pole)

This causes major disruption at work, in relationships, and may lead to hospitalization.

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Types of Bipolar Disorder

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Special Patterns

• 4+ mood episodes (manic or depressive) within 1 year
• More common in women
• Tends to be chronic and harder to treat
• Risk: using antidepressants alone can trigger rapid cycling — be careful!

• Mania and depression happen at the same time
  • e.g., depressed but extremely restless and agitated, OR manic but with no energy to act
• Still carries a high suicide risk
• Antidepressants alone are dangerous here — can worsen mania
• ECT (electroshock) may be indicated

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What Causes Bipolar Disorder?

• Having a first-degree relative (parent/sibling) with bipolar = 10× higher risk

• Losing a parent early, lack of love, childhood abuse

• Emotional conflict, career stress, long-term chronic stress

• Imbalances in serotonin, dopamine, and norepinephrine
• Disruption of biological rhythms (sleep-wake, hormonal cycles)
• Each mood episode makes the brain more sensitive to triggers — called the "kindling effect" (like adding kindling to a fire — it gets easier to ignite each time)

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Conditions That Often Come With Bipolar Disorder

• Substance addiction
• Eating disorders
• Diabetes & cardiovascular disease
• Panic disorder
• Obesity

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Treatment

🔵 Mood Stabilizers (first-line treatment)

🔴 Antipsychotics

• Quetiapine, Olanzapine, others
• Used during both manic and depressive phases

🟡 Antidepressants

• SSRIs preferred when needed
• ⚠️ Must always be combined with a mood stabilizer — antidepressants alone can flip a patient into mania
• Use low doses for short periods only

🟢 Psychotherapy

• Psychoeducation — Teach patients to recognize early warning signs of an episode
• CBT (Cognitive Behavioral Therapy) — Change negative thought patterns
• Family therapy — Help family understand the illness and reduce triggers
• Interpersonal & social rhythm therapy — Stabilize daily routines (sleep, meals, activity) to prevent relapses

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💡 Quick Comparison: Depression vs. Bipolar

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💡 One-Sentence Summary

Bipolar disorder is a brain illness where mood swings between crushing depression and reckless highs — requiring lifelong mood stabilizers, careful medication management, and therapy to prevent dangerous episodes.

😰 ANXIETY DISORDERS — Simple Explanation

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What Is Anxiety?

• Unrealistic, vague, or blown way out of proportion
• Not attached to a real threat — or massively exaggerated
• Overwhelming — the person can't control it
• Persistent — it doesn't just go away

Think of it like a fire alarm that goes off constantly, even when there's no fire.

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How Common Is It?

• 15% of people have anxiety disorders at any given time
• 25% lifetime prevalence — 1 in 4 people will experience it at some point
• More common in women than men
• Peak age: 25–44 years old

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What Does Anxiety Feel Like?

🧠 Psychological Symptoms

• Constant worry, stress, feeling of dread
• Fear that something bad is about to happen
• Difficulty concentrating, poor memory
• Irritability, inability to relax

💓 Physical Symptoms (from the nervous system going into overdrive)

• Rapid heartbeat (palpitations)
• Dry mouth
• Muscle twitching, hand tremors
• Shortness of breath, chest tightness
• Stomach discomfort, nausea
• Dizziness, easy startling
• Difficulty swallowing
• Insomnia

This is why anxiety often gets mistaken for heart problems, digestive issues, or other physical conditions.

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What Causes Anxiety?

1. 🧬 Biological (Brain Chemistry)

• The sympathetic nervous system (the body's alarm system) fires too easily
• Too much noradrenaline (the stress hormone messenger) is released
• Too little GABA (the brain's natural "calm down" chemical)
• Result: the brain stays in "danger mode" even when there's no danger

2. 🧪 Learning & Conditioning

• A stressful or traumatic event (accident, loss, trauma) creates anxiety
• The brain then links that anxiety to other situations — even unrelated, less intense ones
• Over time, more and more triggers can cause the same anxious response
• Can also be learned from parents/family who are anxious — children model the behavior

Each bad experience lowers the threshold — it becomes easier and easier to trigger anxiety.

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Types of Anxiety Disorders

⚡ 1. Panic Disorder (Acute Anxiety)

• Sudden, unpredictable panic attacks — no warning
• Rapidly peaks with intense fear + physical symptoms:
  • Racing heart, sweating, shortness of breath, dizziness, feeling of doom
• The attack itself is terrifying — many people think they're having a heart attack
• After attacks, people fear when the next one will happen, which makes it worse

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😟 2. Generalized Anxiety Disorder (GAD)

• Constant, excessive worry about everyday things — work, health, family, money
• Even small problems feel catastrophic
• Symptoms: restlessness, fatigue, trouble concentrating, muscle tension, can't relax
• The worry is present most days, for months

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😨 3. Phobias

• Intense, irrational fear of a specific object or situation
  • Fear of knives, heights, open spaces, blood, animals, etc.
• The fear is way out of proportion to the actual danger
• Person will go to great lengths to avoid that thing or situation
• Just thinking about encountering it causes major anxiety

• Specific phobias (spiders, needles, heights)
• Social phobia (fear of being judged or embarrassed in public)
• Agoraphobia (fear of open/public spaces, often develops after panic attacks)

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🔄 4. Obsessive-Compulsive Disorder (OCD)

• Obsessions — unwanted, intrusive thoughts, images, or urges that won't go away (e.g., "Did I leave the stove on?", fear of contamination)
• Compulsions — repetitive behaviors or rituals done to reduce the anxiety:
  • Washing hands repeatedly
  • Checking locks over and over
  • Arranging objects in a specific order
  • Counting, repeating words
• The person knows these thoughts/behaviors are irrational — but stopping them causes extreme distress
• It's exhausting and time-consuming, taking over daily life

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Treatment

💊 1. Medications (Biological Therapy)

• Benzodiazepines (e.g., Diazepam, Lorazepam) — fast-acting, used short-term
• Buspirone — longer-term, non-addictive

• SSRIs (e.g., Sertraline, Fluoxetine, Escitalopram) — first-line choice
• SNRIs (e.g., Venlafaxine) — also effective
• These work on serotonin and noradrenaline to rebalance brain chemistry

Note: Antidepressants are not just for depression — they are highly effective for anxiety disorders too.

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🧠 2. Psychotherapy

CBT is the gold standard for anxiety — it has the strongest evidence and produces lasting change.

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Quick Summary Table

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💡 One-Sentence Summary

Anxiety disorders happen when the brain's alarm system gets stuck in the "on" position — causing overwhelming fear, physical symptoms, and behavior changes that interfere with daily life, but respond well to medication and therapy.

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• A = describes Bipolar disorder (mania/depression)
• C = describes a panic attack
• D = describes OCD
• E = describes a phobia

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✅ Correct answer: D. Generalized Anxiety Disorder (if that option appears on the full question — the answer choices appear cut off in your message)

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Summary Table

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• "A. Biological therapy: Anti-anxiety and antidepressant medications"
• "B. Psychotherapy"

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Summary Table (Q10–20)

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• A = Bipolar disorder
• C = Panic attack
• D = OCD
• E = Phobia

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Summary Table (Q1–9)