Transcript Psychopathology, or Psychological Disorders

Psychopathology
or Psychological Disorders
KING LEAR
Prevalence
Lifetime Rates by Gender
Disorder
Males
Females
TOTAL (%)
Anxiety
disorder
19
31
25
Unipolar
Depression
13
21
17
2
2
2
Substance
dependence
35
18
27
Any disorder
49
47
48
Mania
Diagnosis: A Necessary Step
Diagnosis
Process of identifying
and grouping mental
disorders with
similar symptoms
DSM-IV American
Psychiatric
Association’s
Diagnostic and
Statistical
Manual of Mental
Disorders (4th Edition)
Advances in diagnosis and therapy are
success stories for clinical psychology/
psychiatry
In 1955, 500,000
institutionalized for
psychological
disorders
Today: 65,000
But mental hygiene arrests continue to
this day (suicide, squalor, starving)
Major Affective Disorders
“The mind is its own place,
and of itself
Can make a Heaven of Hell,
a Hell of Heaven”
- John Milton (Paradise Lost)
Major Affective Disorders
Unipolar
Bipolar
Incidence
Up to 20 %
1.6 %
Age diagnosed
25-45 y
20-30 y
Sex difference
Twice rate for
females
No difference
Suicide attempts
16 %
30 %
Alcoholism %
30 %
30 %
41 %
55 %
15 %
10 %
(10% of most people per year)
MZ concordance
100% shared genes
DZ concordance
~ 50% shared genes
What is Bipolar disorder?
Mood cycles
Creativity & Bipolar
Creativity & Mood Dysfunction
Writers
Controls
Mood disorder
80 %
30 %
Bipolar
43 %
10 %
Addiction
30 %
7%
Suicide
12 %
0%
Iowa Writer’s Workshop, Andreasen, 1987
Other studies find 30x normal incidence rate in writers, musicians
Why are they linked?
Famous Bipolar Artists
Hans Christian Anderson
Ludwig von Beethoven
Lord Byron
Charles Dickens
T. S. Eliot
Ralph Waldo Emerson
William Faukner
F. Scott Fitzgerald
Paul Gauguin
Vincent van Gogh
Ernest Hemingway
Michelangelo
Sylvia Plath
Edgar Allan Poe
Gordon Sumner (Sting)
Peter Tchaikovsky
Leo Tolstoy
Mark Twain
Virginia Woolf
Tennessee Williams
Creativity Connection
• Emotional reactive (unfiltered life)
• Disinhibited (loose associations)
• Absorption (focus)
Intense creative episodes during hypomania
Vicious Cycle of Depression
Beck Depression Inventory (BDI)
Twenty-one dimensions of depression:
1. Sadness
12. Social withdrawal
2. Pessimism
13. Indecisiveness
3. Sense of failure
14 Change in body image
4. Dissatisfaction
15. Retardation
5. Guilt
16. Insomnia
6. Expectation of punishment 17. Fatigability
7. Dislike of self
18. Loss of appetite
8. Self Accusation
19. Loss of Weight
9. Suicidal ideation
20. Somatic preoccupation
10. Episodes of crying
21. Low level of energy
11. Agitation
In past week including today:
0 = I do not feel sad
1= I feel sad
2= I am sad all the time and I can’t snap out of it
3= I am so sad that I can’t stand it
0-63 max score (30+ indicates severe depression)
Aaron Beck
Treatment for Unipolar
Cognitive
Drug
ECT
Improvement
70%
70%
80%
Relapse rate
Moderate
Higher
Higher
Side effects
None
Moderate
severe
Antidepressants
Suicide
30,000 Americans each year
Nearly 2x the homicide rate
8th leading cause of death,
3rd for teens
2 x above the world rate
- 16.7/100K Japan (1997)
- 11.9/100K USA (1997)
Females attempt 3x males,
but males succeed 4x
60% successes with firearms
Since 1950, suicide rates in
teens has tripled
Myth of Sisyphus (Camus): “There
is only one really serious
philosophical question, and that is
suicide”
Suicide in Depression Cycle
Anxiety Disorders
Phobia
Intense
irrational
fear of
object or
situation
Obsessive-Compulsive Disorder
(OCD)
• Obsessions:
repetitive thoughts
- germs, terrible events,
symmetry & order
• Compulsions:
repetitive behaviors
- grooming, rituals,
checking locks,
appliances
Dissociative Identity Disorder
• Previously
Multiple
personality
disorders
(MPD)
Schizophrenia
“Split Mind”
Disorders involving
gross distortions of
thoughts and
perceptions and by
loss of contact with
reality
Scz – the Disorder of Science and Math
Isaac Newton – suffered psychotic break
Albert Einstein – autistic traits, Scz son
John Nash Jr – chronic schizophrenia
Bertrand Russell
James Joyce’s daughter
Syd Barrett (of Pink Floyd)
Socrates (perhaps, or
temporal lobe epilepsy)
Types of Schizophrenia
• Paranoid: Delusions or
hallucinations often include
extreme suspiciousness and
hostility
• Disorganized: Exhibit signs
of illogical thinking and speech
• Catatonic: Exhibit extremes
in motor behavior
• Undifferentiated: Do not
clearly fit into a type
Catatonia
Positive & Negative Symptoms
• Positive Sx: cognitive, emotional, and
behavioral excesses.
– hallucinations, delusions, thought disorders, and bizarre
behaviors.
• Negative Sx: cognitive, emotional, and
behavioral deficits.
– apathy, flattened affect, social withdrawal, inattention, and
slowed speech or no speech.
Schizophrenia rates
•
•
•
•
•
•
•
•
•
1% across all cultures, despite few offspring
Male = females, or slightly more males
More in jails than psychiatric hospitals
50% never accept that they are ill
90% go off meds once+ (relapse within 3y)
Nearly 100% smoke (self-stimulation)
Higher prevalence in lower socioeconomic class
25% full remission, 50% recurrent relapses (living
independently on meds or less autonomously in
group homes), 25% permanently hospitalized
40% attempt suicide, 10% succeed
DSM-IV Criteria
• Delusions
• Hallucinations
• Speech changes
• Motor symptoms
• Mood symptoms
• Cognitive symptoms
Must show 2 of following for 6 months
Delusions – incorrect conclusions
about perceptions
• Peculiar beliefs, culturally based
aliens, secret lovers, paranoia, grandiosity, thought
insertion or broadcast, erotomania
• Ideas of reference
events has special personal meaning
• Magical thinking
control events from afar
DSM-IV Criteria
• Delusions
• Hallucinations
• Speech changes
• Motor symptoms
• Mood symptoms
• Cognitive symptoms
Must show 2 of following for 6 months
Hallucinations
– inaccurate perceptions
Most auditory; some visual, olfactory, tactile
• Commanding voice of authority – God,
historical figure, parent alive or dead
• Derisive, insulting
• Running commentary of life, feelings,
thoughts
DSM-IV Criteria
• Delusions
• Hallucinations
• Speech changes
• Motor symptoms
• Mood symptoms
• Cognitive symptoms
Must show 2 of following for 6 months
Speech changes
• Mute vs pressured (“word salad”)
• Insensitive to the informational needs
of audience
• Overall, a poverty of speech
DSM-IV Criteria
• Delusions
• Hallucinations
• Speech changes
• Motor symptoms
• Mood symptoms
• Cognitive symptoms
Must show 2 of following for 6 months
Motor symptoms
• Catatonia
• Peculiar (e.g., strip naked to greet)
• Bizarre gestures, grimaces
• Stereotypies (rocking, flapping)
• Violence to self, or family members
DSM-IV Criteria
• Delusions
• Hallucinations
• Speech changes
• Motor symptoms
• Mood symptoms
• Cognitive symptoms
Must show 2 of following for 6 months
Mood symptoms
• Blunted, inappropriate, or exaggerated
• Flat affect, anhedonia, avolitional,
vegetative
• Suicidal
DSM-IV Criteria
• Delusions
• Hallucinations
• Speech changes
• Motor symptoms
• Mood symptoms
• Cognitive symptoms
Must show 2 of following for 6 months
Cognitive Symptoms
• Attention disorder
• Loose associations (“knight’s move”)
• Memory impairment
• Executive functioning – serial,
perseveration, monitoring
Knight’s Move
Impaired Theory of Mind
• Failure to monitor
– what different people can know
– one’s own intentional actions
– informational needs of others
– one simply thought something
– mental and physical distinctions
Course of Onset (Warning signs)
• <7y: Failure to develop dominant hand early (55% autistics fail as well)
• 8-12 y: interpersonal problems, poor emotional control, high IQ, sensitive
• 12-16y: cognitive problems begin, underachievement, disorganized
thoughts, poor emotional rapport, few friends
• 17-20y: [prodomal or precursory] withdrawal, decreased grooming,
altered school or work performance, delusions emerging, abuse
hallucinogens like marijuana or LSD
Genetic Component
Risk of developing
schizophrenia in one’s
lifetime increases as
genetic relatedness
with a diagnosed
schizophrenic
increases.
Dopamine hypothesis