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Summary: Psychoses, Affective Disorders, and Anxiety Disorders

Psychosis is characterized by a break from reality. The most common psychosis is schizophrenia, but all the psychoses have overlapping patterns of symptoms and etiology (origins). References to schizophrenia are becoming less frequent, and references to psychosis are taking their place.

Catatonia is listed as a disorder in its own right, because it can occur separ­ately from other psychotic symptoms. The catatonic state is marked by waxy flexibility, a state of semi-paralysis in which limbs can be repositioned and will be held in place. This state can occur in non-human animals in response to stress.

Symptoms of psychosis include delusions (highly unrealistic belief systems treated as true), imagined voices (often attributed to outside sources such as aliens or radio transmissions), and disorders of affect (such as laughing at inappropriate times).

The type of psychosis previously known as paranoid schizophrenia now goes under a slightly different label: schizo­phrenia with paranoia, emphasizing that paranoia is one possible symptom of psychosis along with others. Schizo­phrenia with paranoia is characterized by delusions of persecution involving fantastical conspiracies.

Disorganized speech is very typical of disorganized schizophrenia. Sometimes schizophrenics speak in a "word salad" that makes no sense, or they use "clang associations," stringing together words that contain similar sounds but make no sense together.

There is evidence of a genetic compo­nent to schizophrenia. If one member of a pair of identical twins is schizophrenic, the other is likely to be also. However, this does not always occur, so there is more to the disorder than genetics.

A common thread in the causation of schizophrenia, depression, and anxiety disorders is stress. This means that family environment and other environ­mental factors can be very relevant.

Recent theories suggest that psychoses, depression, and anxiety may all be related to interactions between the front lobes and the amygdala. Circuits that normally trigger alarm reactions to external threats may become over­activated, resulting in abnormalities that ultimately produce biological defects such as reduced growth of neurons around the hippocampus.

Historically, schizophrenia has been regarded as recurrent and disabling, meaning that there is no effective cure. However, new medications such as clozapine are producing dramatic improvements in some individuals.

Mood disorders are called affective (AFF-ect-iv) disorders. Depression is the most common and comes in all degrees of severity. A person with clinical strength depression is unable to function and may feel suicidal. People with depression report great pain, and a person who suffers one depressive episode has about a 50% chance of suffering another.

Women are nearly twice as likely to suffer from depression as men. This may be due to a combination of factors, such as hormonal differences and the tendency of men to mask their depression with alcoholism. Women may experience depression after childbirth, and some people, especially in northern latitudes, experience depression during the winter.

Mania is characterized by wild activity and a "flight of ideas." Sometimes it is combined with depression in the bipolar disorder. Lithium and other drugs can help to dampen the oscillations between mania and depression.

Anxiety disorders are characterized by feelings of dread, discomfort, and alarm. They include generalized or free-floating anxiety, panic attacks, or phobic reactions.

Agoraphobia, a fear of crowds and public places, is often triggered by panic attacks. Panic attacks involve neurotransmitter systems resembling adrenaline, and they can be treated with medications, psychotherapy, or a combination of the two.

Obsessive-compulsive disorder (OCD) is characterized by intrusive patterns of thinking (obsessions) and irrational urges to repeat behaviors (compulsions). Several disorders, including hoarding, hair-pulling, and skin-picking, are now included in the same category as OCD because of their compulsive features and because, like OCD, they are motivated by anxiety that occurs when a compulsive behavior is prevented.

One common variety of OCD involves excessive hand washing. Triggered by a fear of contamination, the hand washing may be so frequent that the skin of the hands is rubbed raw and starts to crack and bleed.

OCD sufferers often realize that their compulsions are irrational but feel helpless to change them. OCD tends to run in families, and sometimes it can be cleared up with cognitive-behavioral therapy or prescription medications.

Write to Dr. Dewey at

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