Transcript Psychological Disorders & Treatment

Psychological Disorders
Ch 13
Psyc103
J. Wright
• T/F: 40% of people develop some type
of mental disorder in their lifetime
• Mental disorders
– 2nd greatest contributor to shortened life
– source of significant human suffering
throughout the ages
• of patient
• of family
• of community
• Madness – lunacy – insanity
– thought by some
• to be a curse (and/or gift) from god(s)
• to be a source of criminality (moral insanity)
• to be a natural symptom of a sick society
• T/F: Only recently has mental illness become
viewed as disorder or disease (medical model).
• Benefits?
• Have natural causes
• Have symptoms
• Worthy of care
• (potentially) curable
Downsides?
what is abnormal?
• All mental disorders involve abnormal mental
states and behaviors.
– That is, they deviate in some way from the norm.
 But, not all mental states/behaviors that deviate
from the norm should be considered mental
disorders.
 With 40% of population developing disorder – what
is the norm and what isn’t?
– Szaz – The Myth Of Mental Illness
• Not a good definition (at least not by itself)
key elements of mental disorders
 Mental states/behaviors that deviate from norms
AND
• Involves disturbances in behavior, thought, or
emotion
• Stems from internal dysfunction
– biological, psychological, both
Q: When is something a disturbance? When is
it a dysfunction?
• Involves significant personal distress or
impairment.
• What if the person isn’t distressed?
– e.g. Camille Claudel
– Historically, what has mattered more is other
people’s distress.
GAF
Global Assessment
of Functioning
• Lack of self-care
• Inability to
communicate
• Inability to interact
• Impaired judgment
• Can’t function in
daily society
– Work, school, friends
• Danger to
self/others
• Avoided by others
Categories of
Metal Disorders
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Distortion of
Sensation
Perception
Emotions
– Levels
– States
• Behavioral
outcomes
• Issues concerning classification
• Co-morbidity
• Consequence of labeling
– Self-fulfilling prophecy
– Social stigma
issues concerning causation
• Diathesis-stress model
– Gene/environment interaction
– Diathesis: internal
predisposition
– Stress: external trigger
• Epigenetics
– Environmental influence
on genetic expression
anxiety disorders
• Generalized anxiety disorder (GAD)
– 2x as many women
– General fear – no specific source
• Social anxiety disorder
• Separation anxiety disorder
• Which of the following is not a form of anxiety disorder?
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A) Panic disorder
B) Phobic disorder
C) Obsessive-compulsive disorder
D) Post-traumatic stress disorder
E) none of the above
• Panic disorder
– Attacks of intense terror
• High sensitivity to anxiety
– Agoraphobia
• Phobic disorder
– Strong fear and avoidance of particular objects/situations
• Obsessive-compulsive disorder
– Overcome with obsessive thoughts/compulsive actions
– Highly ritualized behaviors as coping mechanisms
• Contamination
• Order/Organization
PTSD
• Post-traumatic stress disorder
• Prevalent in high stress situations
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Poverty
Discrimination
Abuse
War zones
• Unpredictable traumatic experiences
• Imbalance in neurotransmitters
– Damage to hippocampus
mood disorders
• Major depressive disorder
– Intense feelings of despair/helplessness, lethargy, gloom, lack of
interest, lack of pleasure
– 3-6 months in duration
– Categories: Melancholic, Psychotic, Catatonic
– Postpartum, Seasonal affective disorder
• Dysthymia
• Common factors involved in depression
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A) biological
B) genetic
C) psychological
D) all of the above
contributors
• Biological factors
– Neurotransmitters – norepinephrine/serotonin
– Neurological processing of emotions
• Reduced activation in left dorsolateral PFC
• Increased activation in right dorsolateral PFC
• Problems with negative emotion regulation
• Psychological factors
– Helplessness theory
• Negative attributes/experiences
• Internal, stable, global
– Q: Does depression cause negative thoughts? Or do
negative thoughts cause depression?
analytic-rumination hypothesis
• “Pain or suffering of any kind…is well adapted to make a
creature guard itself against any great or sudden evil…leading
to the course of action which is most beneficial.” –Darwin
• Depression is like a fever that helps the immune
system fight off infection.
• Withdrawal from distractions
• Extended rumination about problem
– Hyperactivation of left ventolateral PFC leads to increased
analytic attention – intense, focused deliberation
• Negative moods lead to better decision making
analytic-rumination hypothesis
• Heightened creativity & problem-solving
– artists/writers/philosophers 8x more likely to suffer from
depression
– depression intertwined with creative “cognitive style”
– persistence, obsessive/relentless focus
• “Unfortunately, this type of thinking is often
inseparable from the suffering…If you’re on the
cutting edge, then you’re going to bleed.”
– Nancy Andreasen, neuroscientist
• Problems with this view?
• Bipolar disorder
– Mix of manic and
depressive episodes
– Intense highs/intense
lows
• Causes unclear
– Probably genetic
– Early trauma/abuse
• Triggers
– Stress
– Substance abuse
– Brain imbalance
dissociative disorders
• Loss or fragmentation of “self”
– Cognition, emotion, perception, memory
• Coping mechanism for traumatic events
• Depersonalization disorder
– Feeling of disconnection from self; unreality
• Dissociative amnesia
– Impairment of recall resulting from emotional trauma
– Retrograde vs. anterograde amnesia
• Dissociative fugue
– Impaired recall of past, abandonment of past
– Assumption of new identity
• Dissociative identity disorder
– T/F: Same thing as multiple personality disorder
• http://www.youtube.com/watch?v=gfiB82OUXf0&
NR=1&feature=fvwp
• http://www.youtube.com/watch?v=7iHJfIH20TY
• Cause?
– Severe childhood trauma/abuse
– Split/dissociation
– Not associated with SES (middle-income families)
Schizophrenia
• Eugen Bleuler (1857-1939) – Schizophrenia
• Abnormalities in perception and expression of reality
– Hallucinations
– Delusions
– Disorganized speech, thinking, and behavior
• Onset typically occurs in young adulthood
• Contributory factors
– Genetics
– Neurobiology: increased dopamine
• Reduction in brain mass (5-10% over a decade)
– Early environment (trauma)
• Subtypes of schizophrenia
• Paranoid
– Delusions, hallucinations
• Catatonic
– Stupor or disorganized, purposeless behavior
• Disorganized
– Thought disorder, flat affect
• Child-onset schizophrenia
– Related to puberty induced brain development
Schizophrenia
Personality disorders
• Antisocial personality disorder
– "...a pervasive pattern of disregard for, and violation of, the rights of
others that begins in childhood or early adolescence and continues
into adulthood."[
– history of conduct disorder
– sociopath and psychopath
– one study of 22,790 prisoners
• 47% of men and 21% of women were diagnosed with
APD
– less activity in amygdala and hippocampus to
words that elicit fear in non-APD
Behavioral markers
• Even though antisocial personality disorder
cannot be diagnosed before adulthood, the
presence of three behavioral markers, known
as the Macdonald triad, can be found in some
children who go on to develop ASPD.
– Bedwetting
– Abuse of animals
– Pyromania
Diagnosis
• Three or more of the following are required:
– Failure to conform to social norms with respect to lawful behaviors as
indicated by repeatedly performing acts that are grounds for arrest;
– Deceitfulness, as indicated by repeatedly lying, use of aliases, or
conning others for personal profit or pleasure;
– Impulsivity or failure to plan ahead;
– Irritability and aggressiveness, as indicated by repeated physical fights
or assaults;
– Reckless disregard for safety of self or others;
– Consistent irresponsibility, as indicated by repeated failure to sustain
consistent work behavior or honor financial obligations;
– Lack of remorse, as indicated by being indifferent to or rationalizing
having hurt, mistreated, or stolen from another.
Characteristics
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Persistent lying or stealing
Superficial charm
Apparent lack of remorse or empathy; inability to care about hurting others
Inability to keep jobs or stay in school
Impulsivity and/or recklessness
Lack of realistic, long-term goals -- an inability or persistent failure to develop and execute
long-term plans and goals
Inability to make or keep friends, or maintain relationships such as marriage
Poor behavioral controls -- expressions of irritability, annoyance, impatience, threats,
aggression, and verbal abuse; inadequate control of anger and temper
Narcissism, elevated self-appraisal or a sense of extreme entitlement
A persistent agitated or depressed feeling (dysphoria)
A history of childhood conduct disorders
Recurring difficulties with the law
Tendency to violate the boundaries and "rights" of others
Substance abuse
Aggressive, often violent behavior; prone to getting involved in fights
Inability to tolerate boredom
Disregard for the safety of self or others
People with a diagnosis of antisocial personality disorder often experience difficulties with
authority figures.