Chapter 15-Psychological Disorders

Psychology of Life Skills August 13 th , 2008

Criteria of Abnormal Behavior

    What makes someone ‘abnormal?’ Criteria of Abnormal Behavior:  Deviance   Maladaptive Behavior Personal Distress Viewed as disordered when only one criterion met.

Continuum: Normal -------------------------- Abnormal

Classification of Disorders

 Five Axes: I: Clinical Syndromes (anxiety, schizophrenia) II: Personality Disorders (antisocial personality) III: General Medical Conditions (diabetes) IV: Psychosocial & Environmental Problems (stress) V: Global Assessment of Functioning (scale of 1-100)

Prevalence of Psychological Disorders

 44% of adult population will struggle with psych. Disorder at some point in their life

Anxiety Disorders

 A class of disorders marked by feelings of excessive apprehension and anxiety.

Anxiety Disorders

   Generalized Anxiety Disorder (GAD)  Chronic, ‘free-floating’ anxiety  Not tied to a specific threat Phobic Disorder  Persistent and irrational fear of an object/situation that presents no real danger.

Panic Disorder  Recurrent attacks of overwhelming anxiety—usually occur suddenly and unexpectedly.

Anxiety Disorders

 Obsessive-Compulsive Disorder (OCD)  Persistent, uncontrollable intrusions of unwanted thoughts (obsessions) and urges to engage in senseless rituals (compulsions).

Etiology (Cause) of Anxiety Disorders

 Biology   Temperament and sensitivity might make some people more vulnerable to anxiety disorders.

Neurotransmitters: GABA and serotonin.  Learning   An originally neutral stimulus (dog) paired with frightening event (attack).

Person then avoids stimulus.

Etiology of Anxiety Disorders

 Cognitive Factors  Misinterpret harmless situations as threatening   Focus excessive attention on perceived threats Selectively recall info that seems threatening “The Dr. examined little Emma’s growth.”  Stress

Dissociative Disorders

  Class of disorders in which people lose contact with consciousness/memory.

Results in disruption of sense of identity.

Dissociative Disorders

   Dissociative Amnesia  Sudden loss of memory—too extensive to be normal forgetting.

Dissociative Fugue  Loss of memory for personal identity.

Dissociative Identity Disorder  Co-existence in one person of two or more largely complete and different personalities.

Dissociative Disorders are Weird!

  Really?

How often have you: Suddenly realized when driving, that you don’t remember what has happened during all or part of the trip?

Found that you can’t remember whether or not you have just done something or perhaps had just thought about doing it?

Realized when you are listening to someone talk that you didn’t hear part or all of what the person said?

Causes of Dissociative Disorders

    Personality traits like fantasy-proneness?

Patients faking?

Clinicians creating?

A dissociative reaction to trauma?

Mood Disorders

     A class of disorders marked by disturbances in emotion/mood.

Tend to be episodic (come and go) Typically last 3-12 months Unipolar : Emotional extremes involving depression.

Bipolar : Emotional extremes of both depression and mania.

Mood Disorders

  Major Depressive Disorder (MDD)  Persistent feelings of sadness and despair and loss of interest in previous sources of pleasure.

 Multiple episodes Bipolar Disorder  Marked by the experience of both depressed and manic periods (alternating cycles).

 1—2.5% of population affected.

Causes of Mood Disorders

   Genetic Vulnerability   Strong evidence for biological component Twin studies Neurochemical Factors  Norepinephrine and serotonin Cognitive Factors    Learned Helplessness Pessimistic Explanatory Style Hopelessness Theory  Cause and Effect?

Causes of Mood Disorders

  Interpersonal Roots  Inadequate social skills Stress  Most likely an interaction of factors!

Schizophrenic Disorders

  Class of disorders marked by disturbances in thought that affect perceptual, social, and emotional processes.

1% of population affected.

Schizophrenic Disorders

 General Symptoms  Irrational Thought    Deterioration of Adaptive Behavior Distorted Perception Disturbed Emotion

Schizophrenic Disorders

 Two classes of symptoms:   Positive : Hallucinations, delusions, bizarre behavior.

Negative : Flattened emotions, social withdrawal, apathy.

Causes of Schizophrenia

    Genetic Vulnerability  Strong evidence from twin studies Neurochemical  Too much dopamine Brain Abnormalities  Enlarged ventricles  Frontal Lobes Neurodevelopmental  Disruptions to the brain before or at birth

Discussion Question:

 Recent editions of the DSM include everyday problems that are not traditionally thought of as mental illnesses (e.g., developmental coordination disorder, nicotine dependence disorder). Do you think it's appropriate for these kinds of problems to be included among severe psychological disorders such as multiple personality disorder and schizophrenia?

Discussion Question:

 If a person does not pose a threat to anyone else and is not unhappy with his or her behavior, but is socially deviant (e.g., a transvestite), should that person be considered abnormal and mentally ill?

Chapter 16-Psychotherapy

What is Psychotherapy?

• An umbrella term including many types of therapies/treatments.

• Three Main Elements: – Helping Relationship (treatment) – Professional with special training (therapist) – Person in need of help (client)

Who Seeks Therapy?

• 15% of US population/year • Two most common problems: – Anxiety – Depression • Women more likely to seek therapy than men.

• Many people who need therapy don’t receive it.

Who Provides Treatment?

• Psychologists – Clinical and Counseling – Must have doctoral degree • Psychiatrist – Must go to medical school (M.D.) – Emphasize drug therapies • Psychiatric Social Workers • Psychiatric Nurses • Counselors

INSIGHT THERAPIES • Involve verbal interactions intended to enhance clients’ self-knowledge and thus promote healthful changes in personality and behavior.

Client-Centered Therapy • Proponent: Carl Rogers • Goal: Foster self-acceptance and personal growth.

• Techniques: – Genuineness – Unconditional Positive Regard – Empathy – Clarification

Cognitive Therapy • Proponent: Aaron Beck • Goal: Change the way clients think.

• Techniques: – Detect automatic negative thoughts – Subject automatic thoughts to reality testing – ‘Thought Records’—Homework!

THOUGHT RECORD

Evaluating Insight Therapies • Insight therapy superior to no treatment or placebo treatment, and effects are relatively durable.

• Problems with Evaluating Therapy: – Allegiance Effect – Mechanisms of Action/Common Factors

BEHAVIOUR THERAPY • Involve the application of the principles of learning to direct efforts to change client’s maladaptive behaviors.

• Two Premises: – All behavior is a product of learning.

– What has been learned can be unlearned.

• Goal: To change behavior.

Systematic Desensitization • • • Proponent: Joseph Wolpe Goal: Reduce clients’ anxiety through counterconditioning. Techniques: 1) Build an anxiety hierarchy 2) Deep muscle relaxation 3) Work through the hierarchy while remaining relaxed.

Aversion Therapy • Goal: To reduce a particular maladaptive behavior.

• Technique: Pair behavior with a stimulus that elicits an undesirable response.

Evaluating Behavior Therapies • Place a large emphasis on measuring outcomes • Insight vs. Behavioral: – Differences are small – Modestly favour behavioral

BIOMEDICAL THERAPIES • Psychopharmacotherapy: Treatment of mental disorders with medication.

Antipsychotic Drugs • Used to reduce psychotic symptoms, like mental confusion and hallucinations.

• Reduce symptoms in 70% of people.

• Side Effects: – Drowsiness – Tremors, muscle problems • Newer ‘atypical antipsychotics’ have fewer side effects.

Antidepressants • Gradually elevate mood to bring people out of depression.

• Prior to 1987: – Tricyclics – MAO Inhibitors • Today: – SSRIs (Prozac, Paxil, Celexa) – Effective in 2/3 of patients – Link with suicide?

Evaluating Drug Therapies • ‘Pretend’ Cure/Band-Aid?

• Overprescribed?

• Side effects worse than disorder?

• Influence of pharmaceutical agencies on research.

“The Toronto Affair” • David Healy • Offered a job in 2000 at CAMH, Toronto.

• Invited for job talk on November 30, 2000.

• Ghost Writing • December 7, 2000: Job offer retracted.

• Eli Lilly supports 52% of CAMH mood/anxiety budget. • Academic Freedom?

• Healy filed lawsuit • http://www.pharmapolitics.com/

Trends/Issues in Treatment • Blending Treatments—eclectic approach • Multicultural Sensitivity

Discussion Question” • What do you think would be the benefits

and disadvantages of group therapy? Is it possible that it could somehow support the symptoms rather than recovery? Would you prefer to be in group therapy or individual?

Discussion Question: • One of the main assumptions of behavior

therapies is that behavior is a product of learning. On the surface, this seems like a straightforward and reasonable assumption, but do you think that some psychological disorders may develop as a result of genetic factors rather than learning? Why or why not?

Final Exam on Monday, August 18th • Any Questions let me know.