Download phychological disorders

PSYCHOLOGICAL
DISORDERS
Copyright 1998 Allyn & Bacon
What Is Normal and
Abnormal?
A man
kissing
another
man
A man
barking
like a dog
A woman
slapping a
child
A woman
refusing to
eat for
several days
A man
driving a nail
through his
hand
Perspectives on Causes and
Treatment of Disorders
Biological
Perspective
Psychodynamic
Perspective
Learning Perspective
Cognitive Perspective
Humanistic Perspective
Copyright 1998 Allyn & Bacon
What is Abnormal?
Textbook:
“3 D’s”
Distressing
Dysfunctional
Deviance
Abnormal Behavior
Schizophrenia
 Based
on observation and self report
 Signs and Symptoms
 Abnormal
content of thought
 Illogical form of thought
 Distorted perception
 Changed affect
 Impaired sense of self
 Impaired interpersonal functioning
Onset Timing
10
20
30
AGE
40
Period of greatest susceptibility
50
Distinguishing features
flat,
dull, inappropriate mood, blank
stare
confused thinking, rambling train of
thought
detachment, absorption in private
world
severely reduced motivation, indecision
Positive Symptoms of Schizophrenia
Hallucinations
Delusions
Disturbances
in Form of Thought or
Speech
Grossly Disorganized Behavior
Inappropriate Affect
Copyright 1998 Allyn & Bacon
Negative Symptoms of Schizophrenia
Social
Very
Withdrawal
Apathy
Loss of
Motivation
Lack of GoalDirected
Activity
Limited
Speech
Slowed
Movements
Poor Hygiene
and Grooming
Copyright 1998 Allyn & Bacon
Types of Schizophrenia
Catatonic
Disorganized
Paranoid
Undifferentiated
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Causes of Schizophrenia
Genetic
Inheritance
Excessive Dopamine Activity
Copyright 1998 Allyn & Bacon
Ventricle Example
Cortex Cross-Sections
Normal
Schizophrenic
Genetics?
Psychopathology
has been noted among
children of mothers with schizophrenia
than among children in the general
population: the population risk for
schizophrenia is 1 percent, but the risk for
children whose mothers have chronic
schizophrenia is 16 percent -- and even
higher if the father also has schizophrenia
or is in the schizophrenia spectrum
(Kallmann 1938; Parnas et al. 1993).
Types of Schizophrenia
Type
I
 positive
symptoms
 sudden onset
 responds to antipsychotic meds rapidly
Type
II
 negative
symptoms
 poor response to antipsychotic meds
 brain atrophy???
Phases of Schizophrenia
Acute
Rapid
Episode
deterioration, weeks or months
Prodromal
The term "prodrome" is derived from the
Greek word prodromos meaning the
forerunner of an event (Fava and Kellner
1991). In clinical medicine, a prodrome
refers to the early symptoms and signs of an
illness that precede the characteristic
manifestations of the acute, fully
developed...........
illness. For example, measles is
described as having a prodrome of 3
to 4 days characterized by fever,
coryzal symptoms, conjunctivitis,
and cough. This is followed by the
specific rash, making definitive
diagnosis possible (Yung and Stanley
1989).
Prodromal....
 clear
deterioration not due to substances
Typical symptoms
marked social isolation or withdrawal
impairment in role functioning
markedly peculiar behavior
digressive, vague or poverty of speech
odd beliefs or thinking
unusual perceptual experiences
Residual
Phase
Psychotic
features may be absent
Sense of apathy
Difficulties in thinking, language
Harboring unusual ideas
Subtypes of Schizophrenia
Catatonic: rigid posturing, stupor
Disorganized: silly, giddy, emotional
Paranoid: Delusions of persecution, often
anger
Undifferentiated
Residual
type: multiple
type: Previous episodes, currently
not psychotic, mild signs
Other Psychosis

Schizophreniform Disorder: same
symptoms, 1 - 6 months

Schizoafftective Disorder: hallucinations,
delusions plus mood disturbances
Delusional Disorder
 Brief Psychotic Episode
 Substance Induced Psychotic Disorder
 Psychotic Disorder due to....(specific

medical condition)
Treatment
 Childers
(1964) concludes that the combination
of ECT and drug increases the percentage of
patients who attain a moderate or better
improvement.
 Core positive symptoms (e.g., hallucinations,
delusions, thought disorder) appear to be
significantly reduced by benzodiazepines in
some but not all studies.
 Based on limited data, Plasky (1991) found little
evidence of any efficacy of tricyclic
antidepressants for the negative symptoms of
schizophrenia
ECT treatment
 Erwin
and Thompson (1978) believe that ECT
does not treat the schizophrenic process but
rather treats secondary mood disorders in
schizophrenia
 Patients with schizoaffective disorder and
catatonia had the best response rate (85% and
82%, respectively) to ECT.
“Talk Therapies”
 Psychotherapy
goals are around
management of disorder rather than
“cure”.
 Family therapy is vital to assist in coping.
 Deal with related emotions....anxiety,
depression, frustration, anger
Mood Disorders
Major
Depressive Disorder
Seasonal Depression
Bipolar Disorder
Copyright 1998 Allyn & Bacon
Major Depressive Disorder
Overwhelming
feelings of sadness,
despair, hopelessness
Loss
of interest in pleasurable
activities
Common Symptoms
 Mood
swings
 Tearfulness
 Irritability
 Apathy
 Loss of energy
 Concentration/attention problems
 Indecision
 Pervasive mood of sadness
Symptoms.....
Negativity
and pessimism
Guilt, self-reproach
Psychomotor retardation or agitation
Changes in appetite, weight
Sleep difficulties
Thoughts of death or suicide
Withdrawal
Feelings of hopelessness
Variations in Depression
Reactive
Endogenous,
chronic
Drug induced
Medically related (surgery,
postpartum)
Bereavement
Agitated depression
Seasonal Affective Disorder
Dual Diagnosis
Substance
abuse and psychological
disorder
Depression common
Schools of thought
alcohol causes depression
(depressant)
depression leads to use of alcohol
Depression and
Suicide
When
depression goes untreated, its
most tragic cost is suicide. Fifteen
percent of people in whom depression
is overlooked, untreated, or
improperly treated, will commit
suicide. This means about 20,000
lives each year, in North America
alone.
Treatment

there are two very effective treatments for
depression--medication and
psychotherapy
 almost
80% of people with depression improve
with these treatments
 depression becomes more difficult to treat the
longer its symptoms go untreated
 without proper treatment, 10 to 15% of people
who suffer depression commit suicide.
St John’s Wort
There is considerable public
interest in claims that extracts
from the herb Hypericum
perforatum, commonly known as
St. John’s wort, may be an
effective treatment for depression.
Although St. John’s wort is widely
prescribed in Europe, clinical
research in the USA is incomplete.
Gender & Depression
(Data from Kessler, et al., 1994)
Prognosis (1 year)
(APA Data, 1994)
Seasonal Affective Disorder
A greater
than normal mood
fluctuation with the seasons
Related
light
to amount & intensity of
Seasonal Affective Disorder
(After Wurtman & Wurtman,1989)
Bipolar Disorder
 Manic
episodes & extreme depression mixed
with normal affect
 Mania
involves delusional levels of optimism,
euphoria, & energy
 Equally
common in both sexes
 Sufferers
make poor decisions while manic,
withdraw when depressed
Bipolar Disorder
(Data from Kessler, et al., 1994)
Genetic Connection
Moderate
in major depressive
disorder
Strong
in bipolar depression
Causes & Treatments
 Depression:
low norepinephrine & serotonin levels
 Mania:
high norepinephrine levels
 Major
Depressive Disorder:
serotonin selective reuptake inhibitors (e.g. Prozac)
Causes & Treatments
Bipolar
Depression:
lithium carbonate
Neurotransmitter
levels may be
symptomatic of depression, not causal
Cognitive
theory attributes depression to
distorted thinking
Distorted Thinking
Includes
negative views of the world,
the future, the self
Tied
to poor reality testing, learned
helplessness
Causes of Major Depression
and Bipolar Disorder
The
Biological Perspective
The Cognitive Perspective
The Psychodynamic Explanation
Copyright 1998 Allyn & Bacon
Anxiety Disorders
Generalized Anxiety
Panic
Disorder
Disorder
Phobias
Obsessive-Compulsive Disorder
Copyright 1998 Allyn & Bacon
Anxiety Disorders
Fears &
Phobias
Panic
Disorder
Generalized
Anxiety
Disorder
Obsessive
Compulsive
Disorder
Phobias: Lifetime Prevalence
Obsessive Compulsives
Obsessions:
persistent,
uncontrollable
thoughts
Obsessive Compulsives
Compulsions:
intrusive,
inappropriate
actions that
often prevent
obsessions
Obsessive Compulsives
Obsessions
Reduce
Compulsions
Anxiety
Somatoform Disorders
Hypochondriasis
Conversion
Disorder
Copyright 1998 Allyn & Bacon
Dissociative Disorders
Dissociative Amnesia
Dissociative
Fugue
Dissociative Identity Disorder
Copyright 1998 Allyn & Bacon
Other Psychological Disorders
Sexual
and Gender
Identity Disorders
Personality
Disorders
Copyright 1998 Allyn & Bacon