Descriptive Psychopathology: The Signs and Symptoms of ...

75 Chapter 3: The brain and psychopathologythe body: impaired immunity, atherosclerosis, obesity, bone demineralization,and atrophy of nerve cells in brain. These are reported in persons with manicdepressiveillness and in patients with chronic anxiety disorders. 111The serotonin–noradrenergic–glucocorticoid system supports the stress response.112 Under normal physiological conditions this assemblage protects thebrain’s adaptive systems against extreme fluctuation in sensory input. Impairmentin this system, however, triggers brain changes associated with chronic anhedonia(e.g. the “concentration camp syndrome”) and other depressive-like syndromes. 113Under conditions of sustained or intense stress, neurochemical utilization eventuallyexceeds synthesis and reduction in amine function occurs. This reduction ismediated by the nature of the stressor (e.g. uncontrollable or not), experientialfactors (e.g. prior exposure to acute stressors), or variables specific to the individual(e.g. age). Because of the reduced amine concentrations the individual is lessprepared to respond to the demands of future stress. The more persistent thereduction in amine function, the greater the likelihood of structural pathology. 114Repeated stress in animal models elicits structural remodeling in brain regionsinvolved in memory and emotions (e.g. hippocampus, amygdala, and prefrontalcortex) that is associated with impairments in memory, and the inappropriateexpression of anxiety and aggressiveness. 115 Studies of humans experiencingprolonged and intense stress and the emotional response to the stress report suchpathology. 116The neurology of manic-depressive illnessManic-depression is a disease with substantial heritability that affects the limbicsystem and frontal circuitry. The ventral emotion generation system is directlyaffected, eliciting characteristic problems in behavior (see Chapter 8) and cognition,neuroendocrine and ultradian and circadian rhythm perturbations, andbrain metabolic and structural abnormalities. 117Cognitive deficits are seen in acute mania and melancholia. For many sufferers,the problems remain even when symptoms resolve. While such patients donot exhibit overall decline in intellectual functioning, they do experience adysexecutive syndrome.Manic and hypomanic patients have problems in sustained attention, exhibitingdeficits in both acquisition and retention of verbal and non-verbal memory. 118Compared to patients with schizophrenia, manic-depressive patients have fargreater visuospatial problems. 119Being euthymic does not guarantee good functioning. Of asymptomaticmanic-depressive patients who are not demented, 30–50% nevertheless functionpoorly and have substantial impairment in several cognitive domains, includingverbal memory and learning, oral fluency, visual organization and reasoning, and