Download Psychological Disorders

Mental illness is an equal opportunity threat to success
happiness, and contentment in life and can be found
among all people of the world irrespective of age, race,
gender, religion, ancestry, culture, region, social class.
You cannot infer personal weakness, bad breeding, a
lack of character, or problematic parenting from mental
illness. Both genetics and environment are apparent
contributing causes for most types of mental disorders.
Slide prepared by Dr. Gordon Vessels 2005
Mental health can be described as
functioning
that results in productive activities,
fulfilling relationships, the absence of
serious emotional distress and reality
distortion, and the resilience
to adapt and cope with adversity and
change.
Mental illness refers to any and all
diagnosable mental disorders that (a) are
Slide prepared by Dr. Gordon Vessels 2005
What Is Abnormality in Mental
Health ???
Three criteria
• Deviant
• Maladaptive
• Causing personal
distress
A continuum
from normal to
abnormal
Slide prepared by Dr. Gordon Vessels 2005
Deviance
Distress/Discomfort
Dysfunctional Behavior
ABNORMAL
NORMAL
The 3 most important defining aspects of abnormality.
Three defining aspects of abnormality on a continuum.
There is no distinct or specific boundary between normality and
abnormality. Behavior, thinking, and emotions are normal or
abnormal by degree based on the extent to which actions, thoughts,
and feelings are deviant, personally distressing, dysfunctional or
maladaptive, and potentially dangerous to self or others.
Similar slide retrieved at http://bama.ua.edu/~phill094/Ch%2014%20Monday%20Nov29.ppt#3 No author. This slide arranged by Gordon Vessels, 2005.
“Ds” Reduced:
–
–
–
Abnormality Defined
–
The 4 ‘D’s
Discomfort/
Distress
Deviance
Dysfunction/
Disability/
Maladaptation
Danger
Slide prepared by Dr. Gordon Vessels 2005
“D” Elements of
Abnormality
–
–
–
–
Distress (emotional suffering)
Discomfort (social situations)
Deviancy I (statistically rare)
Deviancy II (in violation of
societal standards or norms)
– Dysfunction (maladaptation
to environmental conditions)
– Danger (to self and/or others
due to irrational, unexpected,
and unpredictable responses
6
Slide prepared by Dr. Gordon Vessels 2005
Time Period
Concepts of Mental Illness
Primitive times
Evil spirits needed to be driven out
Ancient civilizations (Greek and
Roman)
It was thought to be a natural phenomenon - a
relatively scientific and humanistic approach
Middle Ages (500-1300 in Italy and
1500 in Northern Europe)
Supernatural attributions including demon
possession, witchcraft, sorcery, and astrology
such as the movements of the moon.
Renaissance (began in the 14th
century in Italy, and in the 16th
century in northern Europe)
A decline in the belief in demonic possession;
mental problems were irreversible; scientific
inquiry and humanism make progress.
Eighteenth Century
Reform - chains removed; need for medical
care recognized; the first mentally ill patient
was treated rather than abused in a hospital.
Nineteenth Century
Research began and legislation concerning
mental health was enacted; long-term
custodial care hospitals were created.
Twentieth Century
The start of the mental health movement;
state hospitals were built; community health
care centers established; holistic concept of
care and short term care introduced; goal
was to return patients to society, so human
service programs were established; focus
on prevention.
Source: an unnamed nursing student, A history of mental health.
retrieved at http://www.shef.ac.uk/~nmhuk/mhnurs/online/mhhist01.html
Slide. prepared by Dr. Gordon Vessels 2005
Historical reform movements in
mental health treatment in the US
Reform
movement
Era
Setting
Focus of Reform
Moral
Treatment
1800
1850
Asylum
More humane; restorative
treatment goal
Mental
Hygiene
1890
1920
Mental
hospital or
clinic
More prevention; scientific
orientation
Community
Mental
Health
1955
1970
Community
mental health
center
De-institutionalization;
social integration of
mentally ill
Community
Support
1975-
Community
support
Mental illness as a social
welfare problem (e.g.,
housing, employment)
present
Source: Author not identified (2005). Social Policy and Mental Health, a PPT slide show prepared at the School of Social Welfare at UC Berkeley
http://socialwelfare.berkeley.edu/academic/syllabi/summer03/10.mental_illness.sum03.ppt#7 Slide prepared by Dr. Gordon Vessels 2005
Hippocrates
(460 – 370 B.C.)
“Statue” by Bankster Kovacs; http://banxter.com
Copied here with the artist’s written permission
• Looked inside and outside
the body for the causes of mental
disorders.
• Identified four humors – blood,
phlegm, yellow bile, black bile –
a balance kept the body in good
shape while imbalances caused
mental disorders (e.g. excess
black bile caused melancholia).
• Had a typology of personality/
character types that was aligned
with these substances – sanguine,
choleric, melancholic, phlegmatic.
• Introduced the terms: melancholia,
mania, paranoia, and hysteria.
• Used phleboctomy, purgatives,
diuretics, and hypnotics.
Source: Fisar, Z. (2003). Introduction, Development of Psychiatry. Retrieved from
http://www.lf1.cuni.cz/zfisar/psychiatry/Introduction.ppt#7 Slide created by Gordon Vessels, 2005
The Biological Tradition
(Disease Model)
• Hippocrates (450 B.C.): one of the first to consider
that psychopathology could be a disease related
to body fluids or humors
• Galen (150 A.D.): extended Hippocrates work
hundreds of years later.
– Humoral Theory = imbalance in 4 humors, e.g., too much
black bile was thought to cause depression, referred to
as melancholia.
• The Galenic-Hippocratic Tradition
– Anticipated current views linking abnormality with brain
chemical imbalances, and provided
a vocabulary used by physicians for centuries
Slide prepared by Dr. Gordon Vessels 2005
Slide prepared by Dr. Gordon Vessels 2005 ©
Middle Ages & Beyond
Abnormality or deviancy was sadly
interpreted as a battle between good and
evil
– After the fall of the Roman Empire, abnormal
behavior, thinking, and emotion were thought
to be caused by demons, witchcraft, and
sorcery.
– Treatments included exorcism, torture,
burnings, beatings, and crude surgeries.
Astrological explanations also offered.
– Lunacy caused by movements of the moon
(luna meaning moon)
– This is not part of current scientific thinking,
Painting entitled
“When I meet God”
by Bankster Kovacs
but even today many
people
believe
in2004; http://banxter.com
/ Copied here from his website with his written permission.
Background painting titled “I am the Doorway” by Steve Saugulis aka t-gar Check out this artist’s work at http://www.goolis-art.com Used here with written permission
Renaissance (1300 to 1699)
The belief that mental illness was caused by evil spirits carried
into the Renaissance. Paracelsus (1493-1541) did not believe this,
but he was unable to change the status quo. The mentally ill were
put in prisons and prison-like asylums. Asylums were introduced
in the sixteenth century. The word “care” at this time meant
removal from society. Lunatics were described as dangerous,
defective and incompetent. Their condition was considered
irreversible. In 1403 the Bethlem Royal Hospital in London
began accepting lunatics. It was infamous for the brutal
treatment of patients. Doctors allowed visitors to view
lunatics in zoo-like cages. It wasn’t until 1700 that the
insane were called “patients.” It was not until the
last half of the 18th century that this ended.
Source: an unnamed nursing student who wrote, A history of mental health. retrieved at
http://www.shef.ac.uk/~nmhuk/mhnurs/online/mhhist01.html
Slide. prepared by Dr. Gordon Vessels 2005
Slide prepared by Dr. Gordon Vessels 2005 ©
During 1733-1815, Franz Mesmer pioneered a therapeutic approach to
behavior. He suggested that the mentally ill could be cured by holding rods
filled with iron filings in water. He thought that this gave people balance in
the universe. This technique proved to be wrong, but the term "mesmerized"
is from Mesmer. Philipe Pinel (1745-1826) removed the chains from 12
patients in Bicetre Hospital in 1792 - this began a move towards more
humane care of patients.
Iron rods filled with what?
I’m not doing it unless I can
hold it in a bucket of your
blood, you flat-faced lunatic!
The Eighteenth Century
Source: an unnamed nursing student who wrote, A history of mental health. Retrieved at
http://www.shef.ac.uk/~nmhuk/mhnurs/online/mhhist01.html Background painting titled “Cannibal” by Steve
Saugulis aka t-gar Used here with his written permission. Slide. prepared by Dr. Gordon Vessels 2005
Oh Franzie! You
wouldn’t try to have
your way with me
would you big boy.
I can’t believe she’s
buying this invisible
juice nonsense.
Franz
Mesmer
• Coined terms “animal
magnetism”
• Cure brought about
through transmission
of an invisible
fluid ???
• Psychological rather
than physical cause
proposed
Slide prepared by Dr. Gordon Vessels 2005
Jean Martin Charcot (1825-93)
I also won a beauty contest.
OK, your right. It was the
mule category at the fair,
but that doesn’t mean I’m
not real pretty.
• Tried to solve
hysteria puzzle
• Used hypnosis to
treat “hysterical”
patients
• Was Sigmund
Freud’s teacher
Slide prepared by Dr. Gordon Vessels 2005
The 19th Century
The discovery of Syphilis (General
Paresis) and its link with “madness”
–
Syphilis causes psychotic
symptoms in late stages
(delusions, hallucinations).
–
L. Pasteur found the cause –
a bacterial microorganism.
–
Penicillin was found to be a successful treatment in 1870.
–
This link reinforced the view that mental illness should be
treated like a physical illness.
–
Today the pendulum has swung too far in the direction of
seeing mental illness only as a physical illness. This view is held
by physicians and not most psychologists. Psychologists
acknowledge contributing physical causes but continue to
emphasize the role of the environment.
Slide prepared by Dr. Gordon Vessels 2005
Last half of the 19th century
Psychiatric Disorders & Mental Retardation
Early Distinctions
A child with
mental retardation
was called an
A child with
Psychiatric Disorder
was called a
A child with normal
cognition but
disturbed behavior
“Imbecile”
“Lunatic”
“Morally Insane”
Slide prepared by Dr. Gordon Vessels 2005
Fascism and the
World War II Era
• 1933 - law about
prevention of hereditable
illnesses; 400,000
persons sterilized
• 1939 – euthanasia
permitted; T4 action;
10,000 children
murdered
• 1939-1945 – 180,000
psychiatric patients
murdered in Germany
Fisar, Zdenek (2005). [email: [email protected].]. Dept. of Psychiatry at Charles University in
Prague (Mudr Jiri Raboch, Drsc., Head), Introduction: development of psychiatry. A PPT
slide presentation retrieved from http://www.lf1.cuni.cz/zfisar/psychiatry/Introduction.ppt#14
Slide prepared by Gordon Vessels, 2005
Art entitled “Monster” is used here with permission from Steve
Saugulis aks t-gar. Check out his work at http://www.goolis-art.com
The most popular current
perspective about cause is a
Bio-psycho-social view:
– Most mental disorders develop when a
biological or genetic predisposition (a
diasthesis) is triggered by stressful
environmental events or circumstances.
– Biological, psychological, and social risk
factors all play a role in the development of
mental disorders.
Slide prepared by Dr. Gordon Vessels 2005
Bio-Psycho-Social Model of Abnormal Behavior
Trigger event is a biology
film that has lots of blood
16 year old female student
Biological Influences
• inherited over-reactive
sinoaortic baroreflex arc
• Vasovagal syncope: rate
• and blood pressure
• increase, body overcompensates
• Light headedness and
queasiness
• Judy faints
Social Influences
Behavioral Influences
• Judy’s fainting causes
disruptions in school and
at home
• Friends and family rush
to help her
• Principal suspends her
• Doctor says nothing is
physically wrong
• Conditioned response to
sight of blood: similar
situations ─ even words ─
produce same reaction
• Tendency to escape and
avoid situations involving
blood
Psychological Influence
• Increased fear and anxiety
supporting the diagnosis of
an anxiety disorder
DISORDER
Slide prepared by Dr. Gordon Vessels 2005
Perspectives on the Causes of Mental
Disorders
 Psychodynamic - mental disorders originate in intrapsychic
conflict traceable to early childhood experiences.
 Medical/Biological - mental disorders are caused by specific
abnormalities of the brain and nervous system.
 Cognitive-Behavioral - mental disorders are learned
dysfunctional behavior patterns caused by cognitive distortions.
 Humanistic - mental disorders occur when people
are blocked from fulfilling their potential for growth.
 Sociocultural - mental disorders are shaped by culture, and
appear only in certain cultures.
Slide prepared by Dr. Gordon Vessels 2005
Attitudes on Mental Illness
A recent survey of 650 Harris County residents shows greater
empathy and awareness of mental health issues
Do you think
companies that provide
health insurance to
their employees should
or should not be
required to cover
mental health treatment
in the same way as
treatment for other
illnesses?
Should
Should
86%
not
6%
Don’t
know/no
answer 8%
In your opinion, is
mental illness
primarily due to . . .
How concerned
would you be if you
discovered that a
person being treated
for a mental illness
was living in your
neighborhood?
Brain
Something
Disorder
Else
63%
17%
Somewhat
Not
concerned concerned
33%
48%
Don’t
Know/no
answer
Don’t
Very
know/no concerned
Answer 5%
14%
Character
flaw 5%
Source: Houston Area Survey (2004) from the Chronicle, a local newspaper
Slide prepared by Dr. Gordon Vessels 2005
Slide prepared by Dr. Gordon Vessels 2005
All children face some mental health problems
such as the following:
•
•
•
•
•
•
•
•
•
•
•
•
•
Problems dealing with parents & teachers
Anxiety about school performance
Unhealthy peer pressure
Facing tough decisions
Developmental
adjustment problems
School phobia
Suicidal ideation
Drug or alcohol use
Worrying about sexuality
Fears about starting school
Dealing with death or divorce
Feeling depressed or overwhelmed
Considering dropping out of school
/
My Bleeding Doll by MistaBobby; http://mistabobby.deviantart.com Artwork used here with the artist’s writtenpermission.
Major Diagnostic Categories
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
Disorders Usually First Diagnosed in
Infancy, Childhood, or Adolescence,
e.g., ADHD
Substance-related disorders
Sexual and Gender Identity
Disorders
Schizophrenia
Mood Disorders
Diagnostic & Statistical Manual of Mental Disorders
Anxiety Disorders
Somatoform Disorders
Dissociative Disorders
Sleep Disorders
Eating Disorders
Goals of Classification
Factitious Disorders
 Describe a disorder
Adjustment Disorders
 Predict its future course
Impulse-control Disorders
 Imply appropriate treatment
Personality Disorders
 Stimulate research into its cause
Delirium, Dementia, Amnestic,
and Other Cognitive Disorders
Classification describes and
orders clusters
of symptoms
DSM-IV
Slide prepared by Dr. Gordon Vessels 2005
Top Ten Principal Causes of Years Lived with
Disability in Advanced Countries 1990
depression
alcohol
osteoart.
dementia
sch
bp
cerebr.vasc.
ocd
accidents
diabetes
10000
9000
8000
7000
6000
5000
4000
3000
2000
1000
0
YLD
Murray and Lopez (1997). Murray, C.J.L. & Lopez, A.D. (Eds) (1996). The Global
Burden of Disease. Harvard University Press; Murray, C. J. L. & Lopez, A. (1996)
Global Health Statistics: A Compendium of Incidence, Prevalence and Mortality
Estimates for over 2000 Conditions. Cambridge: Harvard School of Public Health.
Fisar, Zdenek (2005). [email: [email protected].]. Dept. of Psychiatry at Charles University in Prague (Mudr Jiri Raboch, Drsc., Head), Introduction: development of
psychiatry. A PPT slide presentation retrieved from http://www.lf1.cuni.cz/zfisar/psychiatry/Introduction.ppt#24 Slide prepared by Gordon Vessels, 2005.
Common and Uncommon Phobias
Percentage of people surveyed
100
90
80
70
60
50
40
30
20
10
0
Snakes
Being Mice Flying Being Spiders Thunder Being Dogs
in high,
on an closed in, and
and
alone
exposed
airplane in a
insects lightning In a
places
small
house
place
at night
Afraid of it
Bothers slightly
Driving
a car
Being
Cats
In a
crowd
of people
Not at all afraid of it
Fisar, Zdenek (2005). [email: [email protected].]. Dept. of Psychiatry at Charles University in Prague (Mudr Jiri Raboch, Drsc., Head), Introduction,
development of psychiatry. A PPT slide presentation retrieved from http://www.lf1.cuni.cz/zfisar/psychiatry/Introduction.ppt#24 Slide prepared by Gordon Vessels, 2005.
Common Obsessions and Compulsions Among People with
Obsessive-Compulsive Disorder (OCD), an Anxiety Disorder
Type of Obsession or Compulsion
Percentage
Reporting Symptom
Obsessions (repetitive thoughts)
Concern with dirt, germs, or toxins (e.g. Howard Hughes)
40
Something terrible happening (fire, death, illness, rape, injury
24
Symmetry, order, exactness, neatness (“neat freaks”; perfectionists)
17
Compulsions (repetitive behaviors)
Excessive hand washing, bathing, tooth brushing, or grooming
85
Repeating rituals (in/out of door, avoiding cracks in sidewalk)
51
Checking doors, locks, car brake, homework, children, etc.
46
Slide prepared by Dr. Gordon Vessels 2005
Depression: Men compared to Women
Percentage of population aged 1884 Experiencing major depression
at some point in life
25
Around the world
women are more
susceptible to
depression
20
20
15
15
10
10
5
5
0
0
USA
Canada
Males
Puerto
Rico
Females
France
West
Germany
Italy
Lebanon Taiwan
Korea
New
Zealand
2 Kessler, R. et al. (1995) Archives of General Psychiatry; Volume 52: 1048-1060.
Slide prepared by Dr. Gordon Vessels 2005
60
Co-morbidity in Post Traumatic Stress
Disorder, i.e. other disorders
Male
suffered by those with PTSD
Female
Comorbidity (%)
50
40
30
20
10
Major
Gen.
Panic
Depressive Anxiety Disorder
Episode
Disorder
Social
Anxiety
Disorder
Agora
phobia
Alcohol
Abuse
Drug
Abuse/
Dependence
Kessler R. et al. (1995). Archives of General Psychiatry. 52:1048-1060.
Slide prepared by Dr. Gordon Vessels 2005
Prevalence of Trauma and Related Probability of PTSD
40
Prevalence of Trauma
Male
Female
1
30
% 20
10
0
Witness
70
60
50
% 40
30
20
10
Accident
Threat w/
Weapon
Physical
Attack
Molestation Combat
Rape
2 Disorder
Probability of Post Traumatic Stress
0
Witness
Accident
Threat w/
Weapon
Physical
Attack
Molestation Combat
Rape
1 Kessler, R. et al. (2000) Journal of Clinical Psychiatry, Volume 61(Suppl 5):4-14.
2 Kessler, R. et al. (1995) Archives of General Psychiatry; Volume 52: 1048-1060.
Slide prepared by Dr. Gordon Vessels 2005
Proportion of Population with Mental Disorders During Lifetime
Disorder Type
3
6 9 12 15 18 21 24 27 30 33 36 39 42 45 48 51
Any Disorder
Substance Abuse
Anxiety Disorders
Mood Disorders
Schizophrenia
Prevalence of Mental Disorders
Estimated percentage of people who have suffered mental disorders during their lives. The estimates
are based on the Epidemiological Catchment Area studies and the National Co-morbidity Study, as
summarized by Regier and Burke (2000) and Dew, Bromet, and Switzer (2000).
Slide prepared by Dr. Gordon Vessels 2005
Positron emission tomography (PET)
produces scanned
images of the
human brain.
Schizophrenia
Normal
Manic-Depression
Red, pink, and orange indicate lower levels of brain
activation; white and blue indicate higher activation
levels. Activity in the schizophrenic’s brain is low in
the frontal lobes, which is at the top (Velakoulis &
Pantelis, 1996). Activity in the manic-depressive’s
brain is low in the left hemisphere and high in the
right hemisphere. The reverse is usually true for
schizophrenics. Researchers are finding consistent
patterns that will aid in diagnosing mental disorders.
Slide prepared by Dr. Gordon Vessels 2005
Lifetime risk of developing
Schizophrenia for relatives of a
schizophrenic
Risk of Schizophrenia
46%
Contributing genetic cause – the
hereditability Index is high
17%
17%
Children
of one
schizophrenic
Fraternal
twin
48%
9%
1%
General
population
Siblings
Children
Identical
of two
twin
schizophrenics
Sources: Lenzenweger, Mark F. and Dworkin, Robert H., Editors (1989 Origins and Development of Schizophrenia : Advances in Experimental Psychopathology;
Gottesman, Irving I. and Moldin, Stephen O. (1998). Genotypes, genes, genesis, and pathogenesis in schizophrenia (first chapter in the former). Slide by Vessels 2005
Symptoms of Schizophrenia
The severity of symptoms varies
from one person to another,
and, typically, symptoms will
decline and then reappear.
Symptoms are divided into
Positive and Negative.
Artwork entitled “Duality” is by Steve Saugulis aka t-gar is used here with the permission of the artist. Check out his artwork at http://www.goolis-art.com
Slide prepared by Dr. Gordon Vessels 2005
Dimensions Schizophrenia
Positive Symptoms vs Negative Symptoms
disorganized/deluded vs toneless/expressionless
inappropriate emotions vs silence/catatonia
Chronic vs Acute Schizophrenia
slow development/history of social inadequacy
vs
rapid development/reaction to specific life stress
Slide prepared by Dr. Gordon Vessels 2005
“Positive” and “Negative” Symptoms of Schizophrenia
Positive symptoms include abnormal thoughts, perceptions, language, and behavior.
•
•
•
•
•
Delusions: false beliefs/thoughts with no basis in reality
Hallucinations: disturbances of perception (hearing, seeing, or feeling things not there)
Disorganized Thinking/Speech: jumping from topic to topic, responding to questions
with unrelated answers, or speaking incoherently with loosely associated thoughts
Disorganized Behavior: problems in performing routine daily activities
Catatonic Behavior: lowered environmental awareness and responsiveness; rigid
and/or inappropriate postures; resistance to movement or instructions.
Negative symptoms include the constricted range and intensity of emotional expression
and communication, strange body language, and reduced interest in normal activities.
•
•
•
•
•
Blunted (or flat) Affect: decreased emotional expressiveness; unresponsive immobile
facial appearance; reduced eye contact
Alogia: reduced speech; responses detached; dysfluent speech
Avolition: lacking motivation, spontaneity, or initiative; sitting for lengthy periods or
ceasing to participate in work or daily activities
Anhedonia: lacking pleasure or interest in activities that were once enjoyable
Attention Deficit: difficulty concentrating
Slide prepared by Dr. Gordon Vessels 2005
Reconstructing Venus by Shelley Bergen aka Nebu is used here with the written permission of the artist.
Brain Abnormalities
More dopamine receptors
or more sensitive receptors;
Less active in frontal lobe areas;
Low activity in frontal lobes;
Enlarged cerebral ventricles
and/or smaller limbic area
Neurodevelopmental causation, meaning multiple causes:
Genetics or a genetic predisposition could play a slightly more
important causal role than environmental factors such as
stressful experiences, poor early nutrition or illness, and a lack
of expressed emotion in the family.
1 in 100 for the general population
1 in 10 chance if a sibling or parent is schizophrenic
1 in 2 chance if identical twin is schizophrenic or if
both parents are schizophrenic
Slide prepared by Dr. Gordon Vessels 2005
There is no one cause to this
complex and puzzling illness,
but it is thought that a
combination
of genetics,
biology
(virus,
bacteria, or an
infection) and
stressors in
life all play
a role.
Except for
the 50-50 odds
for an identical twin
of a schizophrenic or the
child of two, there is currently no reliable way to predict
whether a person will develop this serious mental
disorder.
“Into the Depths” by Shelley Bergen aka Nebu is used here with her written permission.
Slide prepared by Dr. Gordon Vessels 2005
Aftermath by Psychosomatks (Garetha Botha) is used here with the artist’s written permission.
John Nash is now a famous
Schizophrenic. His life story was
made into a film, A Beautiful Mind.
Slide prepared by Dr. Gordon Vessels 2005
Slide prepared by Dr. Gordon Vessels 2005
Subtypes of Schizophrenia
Paranoid:
Delusions of grandeur or persecution and hallucinations
Disorganized:
Disorganized speech (too vague, abstract , repetitive,
unelaborated, impoverished in content; flat, blunted, or
inappropriate emotion; loosely associated thoughts
Catatonic:
Ranging from rigidly immobile to wildly hyperactive
Undifferentiated
or Residual
Symptoms include those above but symptoms as a whole
do not fit one of the above types; residual means
previously schizophrenic with mild carryover symptoms
Nerida by MistaBobby; http://mistabobby.deviantart.com Artwork used here with the artist’s permission.
Self-Purification by Mista Bobby (Sychophant13X)
Slide prepared by Dr. Gordon Vessels 2005 ©
Disorganized
Thinking
Delusions
Thinking is fragmented and
distorted by false beliefs –
typically about self and
imagined threats to self.
Breakdown in selective
attention leaves the
person easily distracted.
“This morning when I was at Hillside (hospital), I was making a movie. I
was surrounded by movie stars. The security guard was Don Knotts. That
Indian doctor in building 40 was Lou Costello. I’m Mary Poppins. Is this
room painted blue to get me upset?”
“Original Sin” by MistaBobby; http://mistabobby.deviantart.com Artwork
used here with the artist’s written permission.
Presynaptic
Axon
Terminal
Antipsychotic
Drug
Dopamine normally crosses the
synapse between two neurons,
activating the second cell.
Postsynaptic
Dendrite
Receptor Site
Dopamine
Synaptic
Vesicle
Synaptic Gap
Antipsychotic drugs bind to the same
receptor sites as dopamine thus blocking
its action. For schizophrenics, a reduction
in dopamine activity can quiet agitation
and psychotic symptoms.
Slide prepared by Dr. Gordon Vessels 2005
Slide prepared by Dr. Gordon Vessels 2005
Mood Disorders
Artwork entitled “Disgarded” by Steve Saugulis aka t-gar is used here with the artist’s permission; check out this artist’s work at http://www.goolis-art.com
Types of Depression
Mood Disorders
Major Depressive Disorder: experience
prolonged hopelessness and lethargy,
sad or dysphoric mood, etc.
1.
2.
3.
4.
Bipolar Disorder or ManicDepression: alternating between
depression and mania (an
overexcited and
hyperactive state)
Other forms of depression:
Dysthymia, a chronic depressed
mood; Abnormal Bereavement;
Adjustment Disorder with Depressed
Mood; Depressive Personality
Disorder; Depressive Disorders NOS
Slide prepared by Dr. Gordon Vessels 2005
5.
6.
7.
8.
9.
10.
11.
Symptoms of Depression
Frequent or excessive crying
Persistent sad, empty, dysphoric, or
irritable mood and anger (the latter
two common for children)
Loss of interest in activities once
enjoyed (“anhedonia)
Recurring thoughts of death,
suicide, and self-harm; possible
suicide attempts (adults and teens)
Diminished ability to concentrate
and make decisions
Feelings of hopelessness,
helplessness, worthlessness; guilt
misattributed to self; low selfesteem
Poor or excessive appetite resulting
in weight loss or gain
Insomnia or hypersomnia (constant
sleep)
Fatigue, lethargy, loss of energy,
lack of motivation, complacency
Psychomotor agitation or
retardation; headaches and
stomach aches among children
Chronic aches and pains
The neurotransmitter SEROTONIN is low
when a person is depressed. This causes body
changes:
Pain Threshold Lowered: depressed people often feel
more pain with no apparent cause. Back pain is very
common among sufferers.
Sleep Disturbance: the day of a depressed person runs
on an average of 22 hours, not 24. There are spikes in
body temperature throughout the night that cause a
person to wake and not get enough REM sleep.
SSRI medications increase serotonin,
increase activity, lift depression, and may alter
hormonal activity as well activity.
Slide prepared by Dr. Gordon Vessels 2005
Neurotransmitters are held in sacs at the end of the nerve cell.
An electrical signal causes the sacs to merge with the membrane
causing the neurotransmitter to be released into the synapse.
Molecules moves across the gap and bind receptors, which are
special proteins, on the adjacent nerve cell or neuron. When
enough neurotransmitters have been absorbed, the receptors
release the molecules. They are then broken or re-absorbed by
the initial neuron and stored away for future use.
How SSRIs work to reduce the
symptoms of depression and anxiety.
Prozac, Paxil, Zoloft, and other SSRIs enhance the affect of
serotoninby preventing it from being absorbed (called re-uptake).
Redux and other anti-obesity drugs increase serotonin.
There are at least 15 different serotonin receptors, each with a different function
Slide prepared by Dr. Gordon Vessels 2005
Slide prepared by Dr. Gordon Vessels 2005
Stressful situations can help cause depression, but environmental stressors are
more important causes for some types of depression than others. The environment
is least important with Bipolar Disorder, more important for Major Depression and Dysthymia,
and definitive for Adjustment Disorder with Depressed Mood. But there is an intervening personality
factor that determines how we respond to stressors — related to Rotter’s attribution theory of motivation.
Some people
become depressed
not because of their lack
of control over environmental
stressors but because of the way
they habitually explain good and
bad events to themselves. This
explanatory style serves us or
disserves as a mediator thereby
determining if we experience
helplessness and suffer
depression
There are three dimensions to explanatory style: permanent versus temporary, universal versus
specific, and internal versus external. An internal attribution or explanation means one blames
themselves rather than forces out of their control. If a person’s explanation of a failure or
problem is universal, she over-generalizes and gives up quickly. Self-explanations
that see situations as permanent make one more vulnerable. This is a detailed
description of being pessimistic, perhaps with good reason, or optimistic.
Astral Blessings by by MistaBobby; http://mistabobby.deviantart.com Artwork used here with the artist’s permission.
Slide prepared by Dr. Gordon Vessels 2005
25
Rate Per 100,000 Population
20
15
10
5
0
1930
1940
1950
Data for 1933 through 1998
1960
1970
1980
1990
2000
Youth in 15-24 Age Range
Personality Disorder
Paranoid
Obsessive- compulsive
Description (18 or older and multi-year pattern)
Suspiciousness, guarded, tense; extreme distrust of others;
perception of being under attack; hold grudges
Preoccupation with rules and order; inflexible; stiff; indecisive;
perfectionististic tendencies; difficulty enjoying life.
Histrionic
Attention-seeking; preoccupation with attractiveness; anger when
attention seeking fails; highly dramatic, seductive, pretentious;
over-value and devalue relationships; rapidly changing moods.
Borderline
Lack of impulse control; drastic mood swings; sudden anger;
intense unstable relationships; can’t stand to be alone; instability in
behavior, emotion, identity, self-esteem, friendships, etc.
Avoidant
Oversensitivity to rejection; no confidence in initiating and
maintaining social relationships; easily hurt or embarrassed; few
close friends; sticks to routines to avoid new contacts.
Dependent
Uncomfortable being alone; places others’ needs above one’s own
to preserve relationships; wants others to make decisions; wants to
be cared for; submissive.
Slide prepared by Dr. Gordon Vessels 2005 ©
Antisocial
Once called psychopathic or sociopathic; remorseless, selfish,
reckless, deceitful, manipulative, lawbreaking, impulsive.
Narcissistic
Self-absorbed; expects special treatment and adulation;
exaggerated opinion of self; poor perspective taking ability
Schizotypal
Peculiarities of speech, perceptions, appearance, and behavior that
unsettle others; emotionally detached and socially isolated.
Schizoid
Not interested in relationships; indifferent to praise or criticism;
restricted range of emotions (relatively flat affect).
ANXIETY DISORDERS
Approximately 20 to 30% of people
experience an anxiety disorder.
Adjustment Disorder with
Anxious Mood results from
a fear producing psychosocial
environmental stressor and
Ends when the stressor is go
Panic Attacks: recurring and
unpredictable psychophysiological
symptoms that appear in the absence
of an emergency that bring sweating,
shaking, racing heartbeat, fear of dying,
and the feeling of totally losing control.
Once experienced, it brings on a fear of fear
because the experience is so intense. This
can lead to the diagnosis of Panic Disorder.
Generalized Anxiety Disorder: A tense, uneasy, and
apprehensive feeling that is unexplainable and
unavoidable because the cause can’t be identified.
May develop into “Panic Attacks.”
Obsessive-Compulsive Disorder: Obsessions,
or recurring and unwanted thoughts,
impulses, and mental images are usually
connected with behavioral compulsions that
only temporarily relieve anxiety. If not
performed, the person is left with unbearable
anxiety. Obsessions are unwanted thoughts;
compulsions are behaviors the person can’t
stop performing when they are known to be
irrational and sure to preclude happiness.
Phobic Disorders: irrational fear of a specific object
or situation that is out of proportion to the real danger.
People often accept and live with phobias. Fear of
snakes, high places, crowds, public speaking, cats, etc.
Social phobia is referred to as Social Anxiety Disorder.
Separation Anxiety Disorder: child cannot separate from
Mother without suffering extreme distress.
Posttraumatic Stress Disorder (PTSD)
results from experiencing or witnessing
life threatening events that brought fear,
horror, and helplessness. These events
are then re-experienced vividly through
recollections or dreams, or by reacting
physically and emotionally to cues
of the event. Plagued by increased
arousal and a fear of reliving the
event, the victim builds defenses
that interfere with normal social
and occupational functioning.
Slide prepared by Dr. Gordon Vessels 2005
This work of art entitled “The Compounded” is by Gareth Botha aks Psychosomatiks. It is used here with permission. http://www.cleanwaterart.com/
There are many other diagnoses in the DSM-IV. The chart here and on the
next few slides lists many of them. Click on the links and learn more.
Dementia of the Alzheimer’s Type, With Late Onset, Uncomplicated
Dementia due to Pick's Disease
Dementia due to Creutzfeld-Jacob disease
Dementia of the Alzheimer’s Type, With Early Onset, Uncomplicated
Dementia of the Alzheimer’s Type, With Early Onset, With Delirium
Dementia of the Alzheimer’s Type, With Early Onset, With Delusions
Dementia of the Alzheimer’s Type, With Early Onset, With Depressed Mood
Dementia of the Alzheimer’s Type, With Late Onset, With Delusions
Dementia of the Alzheimer’s Type, With Late Onset, With Depressed Mood
Dementia of the Alzheimer’s Type, With Late Onset, With Delirium
Hallucinogen Persisting Perception Disorder (Flashbacks)
Schizophrenia, Disorganized Type
Schizophrenia, Catatonic Type
Schizophrenia, Paranoid Type
Schizophreniform Disorder
Schizoaffective Disorder
Bipolar I Disorder Single Manic Episode
Slide prepared by Dr. Gordon Vessels 2005
There are many other diagnoses in the DSM-IV. The chart found here and
on the next few slides list many of them. Click on the links and learn more.
Anxiety Disorder Due to General Medical Condition
Mood Disorder Due to General Medical Condition
Dementia Due to Head Trauma
Major Depressive Disorder Single Episode
Major Depressive Disorder Recurrent
Bipolar I Disorder Most Recent Episode Hypomanic
Bipolar I Disorder Most Recent Episode Manic
Bipolar I Disorder Most Recent Episode Depressed
Bipolar I Disorder Most Recent Episode Mixed
Bipolar II Disorder
Delusional Disorder
Shared Psychotic Disorder
Brief Psychotic Disorder
Autistic Disorder
Childhood Disintegrative Disorder
Rett's Disorder
Asperger's Disorder
Slide prepared by Dr. Gordon Vessels 2005
There are many other diagnoses in the DSM-IV. The chart found here and
on the next few slides list many of them. Click on the links and learn more.
Pervasive Developmental Disorder NOS
Anxiety Disorder NOS
Panic Disorder Without Agoraphobia
Generalized Anxiety Disorder
Conversion Disorder
Dissociative Amnesia
Dissociative Fugue
Dissociative Identity Disorder
Dissociative Disorder NOS
Panic Disorder With Agoraphobia
Agoraphobia Without History of Panic Disorder
Social Phobia
Specific Phobia
Obsessive-Compulsive Disorder
Dysthymic Disorder
Somatoform Disorder
Paranoid Personality Disorder
Slide prepared by Dr. Gordon Vessels 2005
There are many other diagnoses in the DSM-IV. The chart found here and
on the next few slides list many of them. Click on the links and learn more.
Cyclothymic Disorder
Schizoid Personality Disorder
Schizotypal Personality Disorder
Obsessive-Compulsive Personality Disorder
Histrionic Personality Disorder
Dependent Personality Disorder
Antisocial Personality Disorder
Narcissistic Personality Disorder
Avoidant Personality Disorder
Borderline Personality Disorder
Pedophilia
Transvestic Fetishism
Exhibitionism
Gender Identity Disorder NOS
Gender Identity Disorder in Children or Gender Identity Disorder NOS
Gender Identity Disorder in Adolescents or Adults
Anorexia Nervosa
Slide prepared by Dr. Gordon Vessels 2005
There are many other diagnoses in the DSM-IV. The chart found here and
on the next slide list many of them. Click on the links and learn more.
Tic Disorder NOS
Tourette's Disorder
Sleep Terror Disorder
Sleepwalking Disorder
Acute Stress Disorder
Adjustment Disorder With Depressed Mood
Separation Anxiety Disorder
Adjustment Disorder With Anxiety
Adjustment Disorder With Mixed Anxiety and Depressed Mood
Adjustment Disorder With Disturbance of Conduct
Adjustment Disorder With Mixed Disturbance of Emotions and Conduct
Posttraumatic Stress Disorder
Impulse-Control Disorder NOS
Kleptomania
Intermittent Explosive Disorder
Conduct Disorder
Oppositional Defiant Disorder
Slide prepared by Dr. Gordon Vessels 2005
There are many other diagnoses in the DSM-IV. The chart found here and
on the previous slides list many of them. Click on the links and learn more.
Disruptive Behavior Disorder NOS
Selective Mutism
Identity Problem
Reactive Attachment Disorder of Infancy or Early Childhood
Attention-Deficit/Hyperactivity Disorder Predominantly Inattentive Type
Attention-Deficit/Hyperactivity Disorder Combined Type
Attention-Deficit/Hyperactivity Disorder Predominantly hyperactive-Impulsive Type
Narcolepsy
Adult Antisocial Behavior
Child or Adolescent Antisocial Behavior
Malingering
Bereavement
Pathological Gambling
Enuresis (Not Due to a General Medical Condition)
Encopresis Without Constipation and Overflow Incontinence
Feeding Disorder of Infancy or Early Childhood
Pica
Slide prepared by Dr. Gordon Vessels 2005