Podcast Summary
Understanding the evolutionary origins of mental health conditions: Identifying distinct types of psychosis based on evolutionary purposes can lead to improved diagnosis and treatment approaches.
Understanding the evolutionary origins of mental health conditions, such as anxiety and depression, can help us better diagnose and treat comorbidities in psychosis. Dr. Jeffrey Paul Kahn, an expert in the field, identifies five distinct types of psychosis based on his research and practice experience. These include melancholic depression, atypical depression, social anxiety, panic anxiety, and OCD. By considering the potential evolutionary purposes of these conditions, we may gain new insights into their causes and effective treatments. For instance, social anxiety may have once served to promote social harmony within ancient human groups. This perspective can lead to improved diagnosis and treatment approaches, as detailed in Dr. Kahn's recent book, "Psychotic Disorders Comorbidity Detection Promotes Improved Diagnosis and Treatment."
The role of social anxiety in group dynamics and its evolutionary origins: Social anxiety in groups can lead to less competition and contribute to overall success. This phenomenon, driven by evolutionary wiring, is observed in both humans and animals.
The presence of individuals with varying degrees of social anxiety in a group can lead to less competition for hierarchy and rank, contributing to the overall success of the community. This evolutionary wiring, observed not only in humans but also in animals, influences social dynamics and can be traced back for a long time. Psychosis is a disorder characterized by fixed false beliefs, with two main categories: hallucinations and delusions. While hallucinations, such as hearing voices, can be perceived as real, they play a smaller role in common psychotic disorders compared to delusions. The most common type of delusion is paranoid, where individuals hold false beliefs that they are being persecuted or targeted. Research suggests that each of the five core diagnoses of psychosis has a psychotic version, and together they may account for a significant portion of psychotic disorders.
Impaired social cues processing in psychosis linked to hypofrontality and increased dopamine activity: People with psychosis struggle to process social cues due to frontal lobe impairment and heightened dopamine activity, which can be improved through training to read microexpressions.
The development of psychosis is believed to be influenced by a combination of factors, including hypofrontality and increased dopamine activity. Hypofrontality refers to impaired conscious thought and reduced attention span, which can impede the processing of social cues. On the other hand, increased dopamine activity can lead to heightened instinctive fears and behaviors. Studies have shown that people with psychotic disorders often have reduced ability to recognize social cues, and this could be due to the frontal lobes being unable to filter inborn perceptions of emotion. Microexpression studies suggest that people with psychosis can be trained to improve their ability to read microexpressions, which could help them better understand social cues and improve their overall functioning. Overall, these factors, when combined with certain anxiety or depressive disorder subtypes and difficult circumstances, can contribute to the development of a psychotic disorder.
Botox's impact on emotions and psychotic disorders: Botox, used for wrinkles, can affect emotion detection and expression, especially in individuals with psychotic disorders like schizophrenia and OCS, requiring comprehensive treatment addressing both conditions.
Botox, which is used to paralyze muscles and reduce wrinkles, can impact a person's ability to detect and express emotions, creating a partial emotional vacuum. This effect is particularly notable in individuals with psychotic disorders, such as schizophrenia, where emotional dysregulation and cognitive dysfunction can make it difficult for them to focus on others' emotions. Obsessive-compulsive schizophrenia (OCS) is a less common form of psychotic disorder, characterized by a prior history of OCD and the development of psychotic symptoms, such as delusions and hallucinations, which can resemble psychotic versions of OCD symptoms. Treatment for OCS often involves addressing both the psychotic symptoms and the underlying OCD, allowing for significant improvement in patients' lives.
Differentiating between psychosis and comorbid conditions: Structured interviews can help identify comorbid panic disorder in patients with psychosis, as sudden onset of auditory hallucinations may be accompanied by panic attack symptoms. Treating comorbidities can indirectly help manage psychosis.
In assessing patients with psychosis, it's crucial to differentiate between primary psychotic disorders and comorbid conditions, such as OCD and panic disorder. Doctor Khan shared that certain symptoms, like auditory hallucinations, can hint at the possibility of comorbid panic disorder. In fact, there's evidence suggesting that panic attacks may precede psychotic auditory hallucinations. A structured interview can help patients identify the sudden onset of voices and explore whether it's accompanied by panic attack symptoms. It's important to wait until the patient is stabilized before conducting a thorough interview to get the most accurate history. While patients with schizophrenia may always have auditory hallucinations, these symptoms may be indicative of comorbid panic disorder. Treating the comorbidities can indirectly help manage the psychosis.
Treatment Challenges for Individuals with OCD and Schizophrenia: Individuals with OCD and Schizophrenia face unique challenges in treatment due to hallucinations in Schizophrenia making it hard to recognize OCD. Treatment includes antipsychotics, SSRIs, and clonazepam, but higher SSRI doses for OCD can be tough for Schizophrenia patients. Fixed clonazepam doses and graded interpersonal therapy are suggested.
Individuals with both Obsessive-Compulsive Disorder (OCD) and Schizophrenia face unique challenges in their treatment. The presence of hallucinations in Schizophrenia can make it difficult for patients to recognize their comorbid OCD conditions. A study found a 12.1% prevalence of OCD in Schizophrenia. Treatment involves a combination of antipsychotics, SSRIs, and in some cases, benzodiazepines like clonazepam. However, higher doses of SSRIs required for OCD treatment can be difficult for patients with Schizophrenia to tolerate due to potential exacerbation of psychosis or agitation. A clinical pearl suggested that fixed doses of clonazepam every 12 hours may help these patients tolerate higher doses of SSRIs. Additionally, CBT may not be the best approach for these patients due to potential stress and relapse risk. Instead, a gradual and graded interpersonal therapy focusing on the therapeutic alliance and empathy is recommended.
Improvements in symptoms and functional abilities for some patients with schizophrenia and panic disorder using clonazepam: For select patients with schizophrenia and panic disorder, clonazepam can lead to significant improvements in symptoms and functional abilities. Gradually increasing the dose can help prevent panic attacks, but doctors should carefully consider individual circumstances before prescribing.
For some patients with schizophrenia and comorbid panic disorder, the use of benzodiazepines, specifically clonazepam, can lead to significant improvements in both positive and negative symptoms, as well as functional abilities. This discovery was made in the late 1980s and has since become a common practice. Benzodiazepines, such as clonazepam, have a stronger anti-panic effect compared to other benzodiazepines and can be given every 12 hours to prevent panic attacks. However, it's important to raise the dose gradually and carefully due to initial drowsiness, and to ensure patients are not taking more or less than prescribed. Despite concerns, recent research suggests that the negative effects of benzodiazepines, including clonazepam, may be overstated. Doctors should carefully consider each patient's unique situation before deciding on the best treatment approach.
Effectiveness of Clonazepam in Treating Panic Disorders and Psychosis: Clonazepam can be more effective than SSRIs and tricyclics in treating panic disorders. Adding clonazepam to antipsychotics may benefit those with both panic attacks and psychosis. More research is needed on clonazepam's effectiveness for psychosis without panic disorder.
While SSRIs and tricyclics can help reduce panic symptoms, they may not completely stop them. Clonazepam, on the other hand, can be more effective in completely treating panic disorders. However, there is a lack of substantial research on the use of clonazepam for psychotic disorders. For those with panic attacks and psychosis, adding clonazepam to antipsychotics can be beneficial. Regarding the controversy over benzodiazepines and cognitive function, the speaker has not observed significant problems in his experience. He suggests that studies on the effect of specific benzodiazepines on cognitive function should be examined closely for details on dosage and duration. For individuals with both panic disorder and schizophrenia, there is evidence that clonazepam can help reduce positive, negative symptoms, and hallucinations, but more research is needed to determine its effectiveness in those without panic disorder.
Functional psychotic disorders and their relationship with Benzodiazepines: Research on schizophrenia and related disorders continues, leading to potential reclassifications and debates. Benzodiazepine use may impact cognitive function, but correlation does not prove causation, and other factors must be considered.
The definition and understanding of schizophrenia may change as researchers continue to explore its causes and related conditions. Functional psychotic disorders, including schizophrenia, are proposed to be divided into categories based on specific comorbidities. For instance, persecutory delusional disorder, which involves strong paranoid beliefs without voices, may be a psychotic form of social anxiety. Misdiagnosis of this condition as schizophrenia is common. A meta-analysis published in 2004 found that long-term Benzodiazepine use could lead to a significant reduction in cognitive function. However, correlation does not imply causation, and it's essential to consider other factors, such as the population taking Benzodiazepines, which is often those with anxiety disorders or insomnia. The ongoing debate in the field highlights the need for further research to clarify the nature of schizophrenia and related disorders.
Study finds benzodiazepines may protect against dementia: Contrary to belief, higher benzodiazepine doses linked to lower dementia risk; anxiety disorders may be cause of both conditions
A study published in the American Journal of Psychiatry last year found that people who used higher doses of benzodiazepines were less likely to have dementia compared to those who used lower doses. This goes against the common belief that benzos cause dementia. Instead, it's speculated that untreated anxiety disorders may be the cause. Clinically, many people with dementia have a history of anxiety disorders, which may lead to the prescription of benzos. The relationship between anxiety and dementia is not fully understood, but it's important to consider when assessing and treating patients. Additionally, social anxiety and psychosis may be related, with more severe social anxiety potentially increasing the risk for persecutory delusional disorder. When assessing someone for both conditions, ask the same questions as you would for anyone with social anxiety and consider their history of anxiety symptoms.
Understanding Social Anxiety and Melancholic Depression: Social anxiety involves fear of judgment and evaluation, while melancholic depression is characterized by deep sadness, loss of interest, and potential physical symptoms. Effective diagnosis and treatment require distinguishing between these conditions.
Social anxiety, or social phobia, is a common experience for many people, particularly in situations where they feel they are being evaluated or judged by others. People with social anxiety may fear embarrassment, rejection, or being perceived as an imposter. Some may avoid these situations altogether, while others may confront them in an attempt to conquer their fear. This counterphobic behavior can lead to career advantages, such as heightened skill development and increased attunement to audience reaction. Depression, on the other hand, is a complex mental health condition with various subtypes. Melancholic depression, in particular, is characterized by specific patterns of symptoms, including deep sadness, loss of interest in activities, and increased appetite or weight gain. Understanding these patterns can help in accurate diagnosis and effective treatment. Additionally, it's important to consider other potential causes of depressive symptoms, such as vitamin deficiencies or thyroid issues.
Distinguishing Melancholic and Atypical Depression: Melancholic depression, characterized by pessimism, anhedonia, hopelessness, and suicidal thoughts, typically responds to TCAs and ECT, while atypical depression, marked by oversleeping, increased appetite, and rejection sensitivity, may benefit from SSNRIs and mood stabilizers.
Melancholic depression and atypical depression are two distinct types of major depressive disorders. Melancholic depression, also known as endogenous depression, is characterized by symptoms such as pessimism, anhedonia, hopelessness, loss of appetite, guilt, psychomotor retardation, and unreactive affect. People with melancholic depression often have suicidal thoughts, but they're more likely to act on them as they're getting better than during the depression. Melancholic depression is typically worst in the morning and may respond better to certain medications like TCAs and ECT. On the other hand, atypical depression, also known as reversible depression, is characterized by symptoms such as oversleeping, increased appetite, leaden energy, and rejection sensitivity. People with atypical depression can cheer up briefly, but then return to feeling depressed. Atypical depression is more common than melancholic depression and may respond better to certain medications like SSNRIs and mood stabilizers. When taking a diagnostic history for either type of depression, it's important to ask direct and clear questions to help the person give clear answers. It's also important to consider the potential for comorbidities, such as anxiety or psychosis, and to conduct a thorough evaluation including a physical examination, laboratory tests, and imaging studies as needed.
Understanding the complex relationships between depression and personality disorders: Depression and personality disorders share similarities but are distinct conditions. Atypical depression, associated with avoidant, borderline, and histrionic personality disorders, differs from melancholic depression and bipolar disorder, which also have unique characteristics.
While rejection sensitivity may be adaptive in certain cultures, it can also lead to harmful responses in others, such as anger and social assertion that pushes people away instead of bringing them closer. Additionally, depression and personality disorders share some similarities but are distinct conditions. Atypical depression, a type of depression associated with personality disorders like avoidant, borderline, and histrionic, is different from melancholic depression, which is an acute illness that comes in discrete episodes. Bipolar disorder is also commonly associated with atypical depression, and many people believe that they should be recognized as distinct disorders rather than subtypes of major depression. These complex relationships highlight the importance of understanding the nuances of various mental health conditions and their interconnections.
Changes in diagnosing and treating atypical depression: SSRIs are often the best first options for treating atypical depression, but healthcare professionals must consider individual needs and risks when choosing medication, including potential manic episode triggers for those with bipolar disorder.
The diagnosis and treatment of depression, specifically atypical depression, has undergone significant changes throughout history, with major depression becoming the dominant diagnosis. Clinically, these conditions present differently, and while some antidepressants can be effective for both, others are more suitable for specific types. For atypical depression, the best first options are often SSRIs, which can be boosted with drugs like buspirone or lithium to enhance their effectiveness. These treatments have fewer side effects and risks compared to newer antipsychotics, but there are still concerns about the potential for triggering manic episodes in those with bipolar disorder. Overall, the choice of medication depends on the individual's specific needs and response to treatment. It's important for healthcare professionals to consider the potential risks and benefits of each option and work closely with their patients to find the most effective solution.
The Impact of Mental Health Education for Healthcare Professionals: Raising awareness and understanding about mental health is crucial for individuals and healthcare professionals. Education equips professionals to provide better care for their patients, potentially impacting a larger scale.
Key takeaway from this podcast episode is the importance of raising awareness and understanding about mental health, not just for individuals, but also for healthcare professionals. Dr. Khan emphasized the potential impact on a larger scale if more people are educated and equipped to provide better care for their patients. He also mentioned that listeners who are interested in reading his book can find a discount code and link in the resource library on psychiatrypodcast.com. Although he does not personally benefit financially from book sales, he hopes that the author will. The conversation was enlightening, and Dr. Khan's insights provided valuable perspectives on mental health and the role of healthcare professionals. Despite the desire to explore more topics with him, the episode concluded with appreciation for the engaging discussion and a hopeful promise for a future conversation.
