psychological disorders and treatment blind pig syndrome the belief that one has all illnesses which...

Psychological Disorders and Treatment

Blind Pig Syndrome

The belief that one has all illnesses which one hears about.

Insanity Defense

M’Naughten Rule: Insanity is a legal term that one is not aware or responsible for their own actions.

1954 Durham Rule, says one is not responsible for their actions.

Defining Abnormal Behavior

Any behavior state of emotional distress that causes personal suffering that is self-destructive or maladaptive.

Statistical Deviation: If normal is what most people do, Abnormal behavior deviates from the norm.

Defining Abnormal Behavior

Violation of Cultural Standards: Any action that violates the standards of the group. Having visions: religious blessing in some cultures: Schizophrenic in others.

Maladaptive behavior: Interrupts everyday life significantly.

Defining Abnormal Behavior

Emotional Distress: Feels, angry, anxious afraid or depressed most of the time.

Impaired Judgment: Cannot tell right from wrong or control their own behavior.

Deviant, Distressful & Dysfunctional

1. Deviant behavior (going naked) in one culture may be considered normal, while in others it may lead to arrest.

2. Deviant behavior must accompany distress.

3. If a behavior is dysfunctional it is clearly a disorder.

In the Wodaabe tribe men wear costumes to attract

women. In Western society this would be considered

abnormal.

Carol B

eckwith

Understanding Psychological Disorders

Ancient Treatments of psychological disorders include trephination, exorcism, being caged like

animals, being beaten, burned, castrated, mutilated, or transfused with animal’s blood.

Trephination (boring holes in the skull to remove evil forces)

Medical Model

When physicians discovered that syphilis led to mental disorders, they started using medical models

to review the physical causes of these disorders.

1. Etiology: Cause and development of the disorder.

2. Diagnosis: Identifying (symptoms) and distinguishing one disease from another.

3. Treatment: Treating a disorder in a psychiatric hospital.

4. Prognosis: Forecast about the disorder.

Medical Perspective

Philippe Pinel (1745-1826) from France, insisted that madness was not due to demonic possession, but an ailment of the mind.

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Biopsychosocial Perspective

Assumes that biological, socio-cultural, and psychological factors combine and interact to

produce psychological disorders.

Psychological Disorders

Thomas Szasz

believes that mental illnesses are socially, not medically, defined.

Classifying Psychological Disorders

The American Psychiatric Association rendered a Diagnostic and Statistical Manual of Mental Disorders (DSM) to describe psychological

disorders.

The most recent edition, DSM-IV-TR (Text Revision, 2000), describes 400 psychological

disorders compared to 60 in the 1950s.

Multiaxial Classification

Are Psychosocial or Environmental Problems (school or housing issues) also present?

Axis IV

What is the Global Assessment of the person’s functioning?Axis V

Is a General Medical Condition (diabetes, hypertension or arthritis etc) also present?Axis III

Is a Personality Disorder or Mental Retardation present?

Axis II

Is a Clinical Syndrome (cognitive, anxiety, mood disorders [16 syndromes]) present?

Axis I

Multiaxial Classification

Note 16 syndromes in Axis I

Multiaxial Classification

Note Global Assessment for Axis V

Goals of DSM

1. Describe (400) disorders.2. Determine how prevalent the

disorder is.

Disorders outlined by DSM-IV are reliable. Therefore, diagnoses by different professionals

are similar.

Others criticize DSM-IV for “putting any kind of behavior within the compass of psychiatry.”

Prevalence

Approximately 48% of adults experienced symptoms at least once in their lives

Approximately 80% who experienced symptoms in the last year did NOT seek treatment

Most people seem to deal with symptoms without complete debilitation

Women have higher prevalence of depression and anxiety

Men have higher prevalence of substance abuse and antisocial personality disorder

Psychological Disorders- Etiology

Neurotic Disorder (term seldom used now)

usually distressing but that allows one to think rationally and function socially

Psychotic Disorder person loses contact with reality experiences irrational ideas and

distorted perceptions

Psychological Disorders

To study the abnormal is the best way of understanding the normal.

1. There are 450 million people suffering from psychological disorders (WHO, 2004).

2. Depression and schizophrenia exist in all cultures of the world.

William James (1842-1910)

Problems with Diagnosis

InconsistentOverlappingSelf-Fulfilling prophecyStereotyping/Labeling

Anxiety Disorder

Those diagnosed are usually psychologically healthy in other ways. Know their behavior is irrational.

Characterized by persistent thoughts if dread or fear and impending doom.

Generalized Anxiety Disorder

Continuous state of anxiety, lasts a month or more. Show 3 of the following.

Motor Tension Autonomic Hyperactivity Apprehensive Viligence or Scanning

Model of Development of GAD

GAD has some genetic component Related genetically to major depression Childhood trauma also related to GAD

Genetic predispositionor childhood trauma

GAD following life change or major event

Hypervigilance

Phobias

An unrealistic fear of a specific situation: Activity or thing. Simple phobias (I.e. Claustrophobia).

Agoraphobia: half of all phobia cases: Fear of being alone in public places from which escape or help might be difficult. Usually home is a safe place.

Heritable component

Panic Attacks

A brief feeling of intense fear and impending doom or death accompanied by intense physiological symptoms such as rapid breathing, dizziness and sweaty palms.

Post-Traumatic Stress Disorder

Four or more weeks of the following symptoms constitute post-traumatic stress disorder (PTSD):

1. Haunting memories

2. Nightmares

3. Social withdrawal

4. Jumpy anxiety

5. Sleep problems

Bettm

ann/ Corbis

Resilience to PTSD

Only about 10% of women and 20% of men react to traumatic situations and develop PTSD.

Holocaust survivors show remarkable resilience against traumatic situations.

All major religions of the world suggest that surviving a trauma leads to the growth of an

individual.

Obsessive-Compulsive Disorders

Obsessions: persistent thoughts that seem to come unbidden. Reflect maladaptive ways of reasoning and processing information.

Compulsions: Repetitive ritualized behavior that a person carries out in a stereotypical fashion. Designed to prevent some disaster.

Anxiety Disorders

PET Scan of brain of person with Obsessive/ Compulsive disorder

High metabolic activity (red) in frontal lobe areas involved with directing attention

Behavioral Therapies

Work on changing current behaviors and attitudes. Assumes that behavior IS the problem.

Systematic Desensitization: (Wolpe) Step-by-Step process of getting a subject acclimated to a feared object. Relaxing in a hierarchy that gradually leads to greater fear. Must be relaxed before moving on.

Behavioral Therapies

Flooding: (Implosive Therapy) Take patient directly into their most feared situation. Can be physically harmful.

Counter conditioning: (Mary Cover Jones) Conditions new responses to stimuli that trigger unwanted behavior. Based on classical conditioning.

Behavioral Therapies

Aversive Conditioning: Punishment to replace positive reinforcement that perpetuates a bad habit.

Behavioral Records: and contracts: Ways of changing unwanted habits, keep a running record of when a given habit or behavior occurs.

Behavioral Therapies

Token Economy: Rewards desired behaviors, patient exchanges tokens for various privileges or treats. Usually used in mental health care facilities.

Criticisms: When reinforcement stops, so does wanted behavior. Extrinsically rewarding: person in control of someone else’s behavior.

The Learning Perspective

Investigators believe that fear responses are inculcated through observational learning.

Young monkeys develop fear when they watch other monkeys who are afraid of snakes.

Parents transmit their fears to their children.

The Biological Perspective

Natural Selection has led our ancestors to learn to fear snakes, spiders, and other animals.

Therefore, fear preserves the species.

Twin studies suggest that our genes may be partly responsible for developing fears and

anxiety. Twins are more likely to share phobias.

The Biological Perspective

General anxiety, panic attacks, and even obsessions and compulsions are

biologically measurable as an overarousal of

brain areas involved in impulse control and habitual behaviors.

(PET scans)Anterior Cingulate Cortex

of an OCD patient.

Somatoform Disorders

Somatoform Disorders

psychological disorders in which the symptoms take a somatic (bodily) form without apparent physical cause.

Somatoform Disorders

Conversion Disorders

a rare somatoform disorder in which a person experiences very specific genuine physical symptoms for which no physiological basis can be found.

Somatoform Disorders

Hypochondriasis

a somatoform disorder in which a person misinterprets normal physical sensations as symptoms of a disease.

Mood Disorders

Major Depression: Number one reason that people seek treatment. Tearful for no reason, often think of death and ignore or discount positive events. Thoughts of suicide. Loss of interest in usual activities. Enormous effort just to get up.

Seasonal Affective Disorder

A change in mood as seasons change, generally depression in the winter.

Dysthmic Disorder

Minor depressive episode, fills most of the day nearly everyday for two or more years.

Neurotransmitters & Depression

Post-synapticNeuron

Pre-synapticNeuron

Norepinephrine Serotonin

A reduction of

norepinephrine and

serotonin has been

found in depression.

Drugs that alleviate

mania reduce

norepinephrine.

Biological Perspective

Genetic Influences: Mood disorders run in families. The rate of depression is higher in identical (50%) than fraternal twins (20%).

Linkage analysis and

association studies link

possible genes and

dispositions for depression.

Jerry Irwin P

hotography

The Depressed Brain

PET scans show that brain energy consumption rises and falls with manic and depressive

episodes.

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Social-Cognitive Perspective

The social-cognitive perspective suggests that depression arises partly from self-defeating

beliefs and negative explanatory styles.

Cognitive Bases for Depression

A.T. Beck: depressed people hold pessimistic views of– themselves– the world– the future

Depressed people distort their experiences in negative ways– exaggerate bad experiences– minimize good experiences

Cognitive Bases for Depression

Hopelessness theory– depression results from a pattern of thinking– person loses hope that life will get better– negative experiences are due to stable,

global reasons• e.g., “I didn’t get the job because I’m stupid

and inept” vs. “I didn’t get the job because the interview didn’t go well”

Depression Cycle

1. Negative stressful events.

2. Pessimistic explanatory

style.

3. Hopeless depressed state.

4. These hamper the way the

individual thinks and acts,

fueling personal rejection.

Anti-Depressants

Stimulants that influence neurotransmitters in the brain. Elevates levels of seretonin. Non-addictive, side effects dry mouth, constipation.

Anti-Depressants

Prozac: blocks reabsorption and removal of seretonin from synapses. Cousin of Zoloft and Paxil, side effects, weight gain, dry mouth and dizzy spells.

Lithium: Calms people with manic-depressive disorder. Can be dangerous.

Anti-Depressants

Valium: Tranquilizers, depressants, frequently prescribed to people complaining of unhappiness or anxiety. Least effective and addictive.

Anti-Anxiety Drugs: reduce tension and anxiety without causing excessive sleepiness. Reduce symptoms without resolving underlying problem.

Bipolar Disorder (Manic-Depressive)

Alternate between depression and mania.

Mania

High state of exhilaration (flight of ideas) feelings of power, plans, ambition, widely optimistic. Inflated sense of self-esteem. Speaks dramatically, many jokes or puns.

Personality Disorders

Psychological Disorders in which rigid, maladaptive personality patterns cause personal distress or inability to get along with others. Must be repeating, long-term pattern of behavior.

Personality Disorders

Paranoid personality: Unreasonable and excessive suspiciousness, jealousy, or mistrust. May occur as a personality disorder or with schizophrenia. Interpret other’s actions as threatening; think others are trying to harm them.

Personality Disorders

Avoidant Personality: Extremely sensitive to rejection, therefore avoid relationships unless they bring critical acceptance.

Personality Disorders

Narcissistic: Exaggerated sense of self-importance and self-absorption. Find criticism hard to accept. Require constant attention and feel entitled to special favors, exploit others, arrogant. Preoccupation with one’s self.

Personality Disorders

Histrionic: Displays shallow, attention seeking behavior. Will go to great lengths to gain others praise and reassurance.

Sadistic: Marked by the use of cruel, demeaning and aggressive behavior towards others.

Personality Disorders

Borderline: Display unstable relationships and emotions. Manipulate others. Often involves drastic mood shifts and behavior and may include self-mutilation. Many short-lived relationships.

Personality Disorders

Antisocial: (Psychopath; Sociopath): Characterized by lying, stealing, cheating and lack of social emotions. Feel no remorse, have no conscience. Can lie, seduce and manipulate others.

Dissociative Disorders

Conditions in which normally integrated consciousness or identity is split or altered. Results in memory loss or change of identity.

Psychogenic Amnesia: Partial or complete loss of memory. Not Organic, usually a result of intolerable stress. Little concern for lost memories.

Dissociative Disorders

Psychogenic Fugue: Person takes on a new identity; may remarry, get a new job, live contentedly until suddenly waking up with no memory of the Fugue state.

Dissociative Disorders

Dissociative Identity Disorder: Person with 2 or more distinct personalities, each with their own name and history. Core personality aware of reality so NOT SCHIZOPHRENIA.

Causes: Predisposition, childhood abuse or severe trauma.

Somatoform Disorders

Repeated; Multiple vague physical complaints lasting for several years without medical cause. (Dizziness, shortness of breath).

Somatoform Disorders

Conversion Disorders: Single physical disturbance that seems to express a physiological conflict. Usually stems from trauma. Lacks physical evidence. Post Traumatic Stress Disorder

Somatoform Disorders

Hypochondriac: Unrealistic fear of disease; exaggerate normal physical sensations. Constantly concerned with health. Preoccupied with bodily functions.

Drug Abuse and Addiction

May be influenced by family history. Blackouts, loss of memory; Impaired ability to work or get along with others. Physical illness, Intoxication throughout the day, inability to stop or cut down.

Schizophrenia

Schizophrenia

Delusions: Thoughts that have no basis in fact; Paranoid Schizophrenics take innocent events as evidence. Some have delusions of grandeur. False beliefs.

Hallucinations: Usually take the form of voices and consistent or garbled odd words. Conversation in head seems real.

Schizophrenia

Loose Word Associations: (Word salad, clang associations). Illogical jumble of ideas linked by meaningless rhyming words or by remote associations.

Severe Emotional Abnormalities: Inappropriate or exaggerated emotions; laugh at sad news; weep for no reason. Eventually lose the ability to feel any emotion at all.

Schizophrenia

Withdrawal into Inner World: Live in their own minds. Oblivious to everything around them.

Flat Effect: Zombie like state characteristics of some schizophrenics.

Catatonic: Immobility; abnormal cluster of genes on chromosome 5. Stupor in motor ability. May hold a position for hours, shows definite signs of psychosis.

Schizophrenia

Paranoid: Preoccupied with hallucinations and delusions. Suspicions of others harming one, overly precautions.

Undifferentiated: Does not fit into other categories, but meets basic criteria for schizophrenia.

Disorganized: Disorganized speech or behavior, or flat or inappropriate emotion.

Theories of Schizophrenia

Biological: Chromosomes 6 & 22 related to schizophrenia, but so many symptoms, no single physical deficiency. Abnormal levels of Dopamine. May be overly sensitive to everyday stimuli.

Genetic Factors: 1 in 100 in normal pop,1 in 10 if sibling, 1 in 2 if identical twin.

Brain Disorder: Lack of oxygen to the brain, toxic chemicals; infection (syphilis). Time of year born (Jan-Mar).

Biological FactorsAbnormal Brain Morphology

Schizophrenia patients may exhibit morphological changes in the brain like

enlargement of fluid-filled ventricles.

Both P

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Abnormal Brain Activity

Brain scans show abnormal activity in the frontal cortex, thalamus, and amygdala of

schizophrenic patients. Adolescent schizophrenic patients also have brain lesions.

Paul T

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LA Laboratory of N

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Environmental FactorsViral Infection

Schizophrenia has also been observed in individuals who contracted a viral infection (flu)

during the middle of their fetal development.

Family Influences on Schizophrenia

Family variables– parental communication that is

disorganized, hard-to-follow, or highly emotional

– expressed emotion• highly critical, over-enmeshed families

Cultural Differences in Schizophrenia

Prevalence of symptoms is similar no matter what the culture

Less industrialized countries have better rates of recovery than industrialized countries– families tend to be less critical of the patients– less use of antipsychotic medications, which may

impair full recovery– think of it as transient, rather than chronic and lasting

disorder

Summary of Schizophrenia

Many biological factors seem involved– heredity– neurotransmitters– brain structure abnormalities

Family and cultural factors also important Combined model of schizophrenia

– biological predisposition combined with psychosocial stressors leads to disorder

– Is schizophrenia the maladaptive coping behavior of a biologically vulnerable person?

Theories on Schizophrenia

Anti-Psychotic Drugs: Major tranquilizers (Theorizing, Halodel). Previously used padded cells and straight jackets. Reduce pain and agitation. Shorten episodes. Block receptor sites for dopamine.

Anti-Psychotic Drugs

Clorazil: Sometimes awakens catatonic patients.

Clozapine: Dampens responsiveness to irrelevant stimuli.

Thorazine: Omits delusions and hallucinations.

Psychosurgery

Frontal Lobe Lobotomy: Cut fibers in the frontal lobe. In the 1950s many were conducted, today is is generally illegal, only used in the most severe cases.

Cognitive Therapy

Tries to teach people more positive ways of thinking. Attempts to replace negative thoughts with rational responses.

Internalized Sentences: Talking to one’s self, using self-defeating thoughts. Personalize failure; overgeneralize, jump to conclusions.

Cognitive Therapy

Thought Processes: Need to change thoughts from being internalized, stable and global.

Rational-Emotive Therapy: Albert Ellis (Aaron Beck), vigorously challenges peoples illogical, self-defeating attitudes and assumptions to stop catastrophizing and awufilizing.

Humanistic Therapy

Try to move one toward self-fulfillment and to take responsibility for their actions.

Client-Centered Therapy: (Rogers), listening with genuine acceptance to help them begin to heal themselves (non-directive).

Humanistic Therapy

Existential Therapy: Helps clients find meaning in existence. Gives them the power to control their own destinies.

Active Listening: Echoing, Restating, and seeking clarification of what a person expresses.

Humanistic Therapy

Unconditional Positive Regard: Therapists must be warm and show unshakeable regard for their client. They must be genuine and honest.

Group Therapy

Helps patients express their problems and show that they are not alone in suffering from this illness.

Gestalt Therapy

Commonly used in institutions and prisons. Focuses on looking at an individual as a whole. Can teach individuals to be more self-assertive and to use more self-revelation.

Family Therapy

Usually used to help children and adolescents. Role-Play, facilitate good communication.

Eclectic Approach

Combine one or more treatments to most effectively treat the client. More popular type of treatment.

Effectiveness of Psychotherapy

Good Relationships with therapist seems to be more effective than type of treatment used.

Alternatives: Encounter Groups, self-help tapes, books

Psychosurgery

Destroys selective area of the brain. Last resort.

Electroconvulsive Therapy (ECT): used with major depression; increase brain activity; electrodes attatched to head, throws patient into a short seizure.