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Chapter 18
Major Mental Disorders
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Key Questions

What are the general characteristics of psychosis?

How do delusional disorders differ from other forms of
psychosis?

What forms does schizophrenia take?

What causes schizophrenia?

What are mood disorders? What causes depression?

How are major mental disorders treated?

Who do people commit suicide? Can suicide be prevented?

What does it mean to be “crazy”? What should be done about it?
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Psychosis- “Losing It”
 Page 584
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 Psychosis:
 Loss of contact with shared views of reality
 Hallucinations:
 Imaginary sensations, such as seeing, hearing, or
smelling things that do not exist in the real world
 Most common psychotic hallucination is hearing voices
 Note that olfactory hallucinations sometimes occur with
seizure disorder (epilepsy)
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 Delusions:
 False beliefs that individuals insist are true,
regardless of overwhelming evidence against them
1.
Depressive
2.
Somatic
3.
Grandeur
4.
Influence
5.
Persecution
6.
Reference
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Some More Psychotic
Symptoms
 Flat Affect:

Lack of emotional responsiveness; face is frozen in blank
expression
 Disturbed Verbal Communication:

Garbled and chaotic speech; word salad
 Personality Disintegration:

When an individual’s thoughts, actions, and emotions are
uncoordinated
 Brief Reactive Psychosis:

Psychotic symptoms typically appear after an extremely
stressful event
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Table 18-1
 Common Warning Signs of Psychosis and Major
Mood Disorders

Expresses bizarre thoughts or beliefs that defy reality

Has withdrawn from family members and other relationships

Hears unreal voices, sees things others don’t

Is extremely sad, persistently despondent, or suicidal

Is excessively energetic, has little need for sleep

Loses appetite, sleeps excessively, has no energy

Exhibits extreme mood swings

Believes someone is trying to harm her or him

Has engaged in anti-social, destructive, or self-destructive
behavior
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Other Psychotic
Disorders
 Organic Psychosis:
 Psychosis caused by brain injury (gunshot wound)
or disease
 Functional psychosis
 Based on unknown causes or psychological factors
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Organic Psychosis
 Dementia:
 Most common organic psychosis; serious mental
impairment in old age caused by brain deterioration
 Archaically known as senility (senile dementia)
 Alzheimer’s Disease:
 Symptoms include impaired memory, confusion, and
progressive loss of mental abilities
 Ronald Reagan most famous Alzheimer’s victim
 (Page 587)
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Organic Psychosis
Cinema Education
 The Notebook
 A Moment to Remember (Subtitled)
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Delusional Disorders
 Delusional Disorders:
 Marked by presence of deeply held false beliefs
(delusions)
 May involve delusions of grandeur, persecution,
jealousy, or somatic delusions
 Experiences could really occur!
 Paranoid Psychosis:
 Most common delusional disorder
 Centers on delusions of persecution
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Schizophrenia: The Most
Severe Mental Illness
 Schizophrenia:
 Psychotic disorder characterized by hallucinations,
delusions, apathy, thinking abnormalities, and
“split” between thoughts and emotions
 Does NOT refer to having split or multiple personalities
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The Four Subtypes of
Schizophrenia
 Disorganized (Hebephrenic) Type: Incoherence, grossly
disorganized behavior, bizarre thinking, and flat or
inappropriate emotions
 Catatonic Type: Marked by stupor, unresponsiveness,
posturing, and mutism
 Paranoid Type: Preoccupation with delusions; also involves
auditory hallucinations that are related to a single theme,
especially grandeur or persecution
 Undifferentiated Type: Any type of schizophrenia that does
not have specific paranoid, catatonic, or disorganized
features or symptoms
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© Bruce Ely/Getty Images
Fig. 16.6 Over a period of years, Theodore Kaczynski mailed bombs to unsuspecting victims, many of
whom were maimed or killed. As a young adult, Kaczynski was a brilliant mathematician. At the time of his
arrest, he had become the Unabomber—a reclusive “loner” who deeply mistrusted other people and
modern technology. After his arrest, Kaczynski was judged to be suffering from paranoid schizophrenia.
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Causes of Schizophrenia
 Environment

Psychological Trauma:
 Psychological injury or shock, often caused by violence,
abuse, or neglect

Disturbed Family Environment:
 Stressful or unhealthy family relationships, communication
patterns, and emotional atmosphere

Deviant Communication Patterns:
 Cause guilt, anxiety, anger, confusion, and turmoil

Double-bind communication:
 Places the listener in an unsolvable emotional conflict, or
“no-win” situation
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Causes of Schizophrenia
 Heredity
 Some individual inherit a potential for developing
schizophrenia
 They are more vulnerable to the disorder than others
are
 EX: If 1 identical twin becomes schizophrenic (identical
twins have identical genes) then the other twin has a 48%
chance of also becoming schizophrenic
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Research Classic
 The Genain Sisters- Trouble times four (page 592)
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Fig. 16.7 Lifetime risk of developing schizophrenia is associated with how closely a person is genetically
related to a schizophrenic person. A shared environment also increases the risk. (Estimates from
Lenzenweger & Gottesman, 1994.)
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
Biochemical Causes of
Schizophrenia
Biochemical Abnormality:
 Disturbance in brain’s chemical systems or in the
brain’s neurotransmitters
 Dopamine:
 Neurotransmitter involved with emotions and
muscle movement
 Works in limbic system
 Dopamine overactivity in brain may be related to
schizophrenia
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Fig. 18.3 Dopamine normally crosses the synapse between two neurons, activating the second cell.
Antipsychotic drugs bind to the same receptor sites as dopamine does, blocking its action. In people
suffering from schizophrenia, a reduction in dopamine activity can quiet a person’s agitation and
psychotic symptoms.
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Louis Wain
This series of paintings by Louis Wain
reflects a troubled personality. Wain
was a British illustrator who became
schizophrenic in middle age. As Wain’s
psychosis progressed, his cat paintings
became highly abstract and
fragmented. In many ways, Wain’s
paintings resemble the perceptual
changes caused by psychdelic drugs
such as LSD. Recent research suggests
that psychosis may, in fact, be the result
of mind-altering changes in brain
chemistry
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Schizophrenic Brain
 Computed Tomography (CT) Scan:

Computer enhanced X-ray of brain or body
 Magnetic Resonance Imaging (MRI) Scan:

Computer enhanced three-dimensional image of brain or body;
based on magnetic field

MRIs show schizophrenic brains as having enlarged ventricles
 Positron Emission Tomography (PET) Scan:

Computer-generated color image of brain activity; radioactive
sugar solution is injected into a vein, eventually reaching the
brain

Activity is abnormally low in frontal lobes of schizophrenics
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© Dennis Brack/Stockphoto.com76
Fig. 18.4 (left) CT scan of would-be presidential assassin John Hinkley, Jr., taken when he was 25. The
X-ray image shows widened fissures in the wrinkled surface of Hinkley’s brain. (right) CT scan of a
normal 25-year-old’s brain. In most young adults the surface folds of the brain are pressed together too
tightly to be seen. As a person ages, surface folds of the brain normally become more visible.
Pronounced brain fissuring in young adults may be a sign of schizophrenia, chronic alcoholism, or other
problems.
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Fig. 18.5 Positron emission tomography produces
PET scans of the human brain. In the scans
shown here, red, pink, and orange indicate lower
levels of brain activity; white and blue indicate
higher activity levels. Notice that activity in the
schizophrenic brain is quite low in the frontal
lobes (top area of each scan) (Velakoulis &
Pantelis, 1996). Activity in the manic-depressive
brain is low in the left brain hemisphere and high
in the right brain hemisphere. The reverse is more
often true of the schizophrenic brain. Researchers
are trying to identify consistent patterns like these
to aid diagnosis of mental disorders.
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Schizophrenia
 Beautiful Mind
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Stress-Vulnerability
Model
 Stress-Vulnerability Hypothesis:
 Combination of environmental stress and inherited
susceptibility cause schizophrenic disorders
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Fig. 18.6 Various combinations of vulnerability and stress may produce psychological problems. The top
bar shows low vulnerability and low stress. The result? No problem. The same is true of the next bar down,
where low vulnerability is combined with moderate stress. Even high vulnerability (third bar) may not lead to
problems if stress levels remain low. However, when high vulnerability combines with moderate or high
stress (bottom two bars) the person “crosses the line” and suffers from psychopathology.
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Mood Disorders

Mood disorders:


Depressive Disorders:


Moderate depression that lasts for at least two years
Cyclothymic Disorder:


Involve both depression and mania or hypomania
Dysthymic Disorder:


Sadness or despondency are prolonged, exaggerated, or unreasonable
Bipolar Disorders:


Major disturbances in emotion, such as depression or mania
Moderate manic and depressive behavior that lasts for at least two years
Reactive depression:

Is an episode of despondency that follows some identifiable event
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Major Mood Disorders

Major mood disorders:


Major Depressive Disorder:


Lasting extremes of mood or emotion and sometimes with psychotic features
(hallucinations, delusions)
A mood disorder where the person has suffered one or more intense episodes
of depression; one of the more serious mood disorders
Bipolar I Disorder:

Extreme mania and deep depression; one type of manic-depressive illness


Bipolar II Disorder:


Mania: Excited, hyperactive, energetic, grandiose behavior
Person is mainly sad but has one or more hypomanic episodes (mild mania)
Affective psychosis:

Combination of mood disorder and a break with reality
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Major Mood Disorders
(cont.)
 Endogenous Depression:
 Depression that seems to be produced from
inside the body (due to chemical imbalances)
and NOT from life events
 Seasonal Affective Disorder (SAD):
 Depression that only occurs during fall and
winter
 May be related to reduced exposure to sunlight
 Phototherapy: Extended exposure to bright light to
treat SAD
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Batman and
his Foes
Comic Book characters and their
problems
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Feeling Sad? It Could Be
SAD
 Page 598
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Fig. 18.7 Seasonal affective
disorder appears to be
related to reduced exposure
to daylight during the winter.
SAD affects 1 to 2 percent of
Florida’s population, about
6 percent of the people living
in Maryland and New York
City, and nearly 10 percent of
the residents of New
Hampshire and Alaska
(Booker & Hellekson, 1992).
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© Dan McCoy/Rainbow
Fig. 18.8 An hour or more of bright light a day can dramatically reduce the symptoms of seasonal
affective disorder. Treatment is usually necessary from fall through spring. Light therapy typically works
best when it is used early in the morning (Lewy et al., 1998).
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Maternity Blues
 Maternity Blues:
 Mild depression that lasts for one to two days after
childbirth
 Marked by crying, fitful sleep, tension, anger, and
irritability
 Brief and not too severe
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Postpartum Depression
 Postpartum Depression:
 Moderately severe depression that begins within
three months following childbirth
 Marked by mood swings, despondency, feelings of
inadequacy, and an inability to cope with the new baby
 May last from two months to one year
 Part of the problem may be hormonal
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Fig. 18.9 At least one schizophrenic patient in four had completely recovered 10 years after being
diagnosed. Three out of four had improved. New treatments for schizophrenia and other major mental
disorders may improve these odds. (Source: FDA Consumer, 1993.)
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Therapeutic Interventions
 Psychotherapy:
 Any psychological treatment for behavioral or
emotional problems
 Typically involves two people talking about one’s
personal problems
 Somatic Therapies:
 Bodily
 Drug therapy, hospitalization, or psychosurgery
 Pharmacotherapy:
 Use of drugs to alleviate the symptoms of emotional
disturbance
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Pharmacotherapy
 What type of drugs are used in pharmacotherapy?
 Tranquilizers
 Drugs (Valium) that produce relaxation or reduce anxiety
 Antidepressants
 Are mood elevating drugs used to combat depression
 Antipsychotics
 Drugs that, in addition to having tranquilizing effects, also
tend to reduce hallucinations and delusional thinking.
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Psychiatric “Wonder Drugs”
 Read page 601
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Shock
 Electroconvulsive Therapy (ECT)
 A 150-volt electrical current is passed through the brain
for slightly less than a second
 How does shock help?
 It is the seizure that helps, which is induced by the
shock
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Psychotherapy
 Psychotherapy
 Any surgical alteration of the brain
 Best known psychotherapy
 Prefrontal lobotomy: The frontal lobes are surgically
disconnected from the other areas of the brain
 Deep lesioning: Small target areas are destroyed in the
brain’s interior
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Suicide: Major Risk
Factors
 Drug or alcohol abuse
 Prior suicide attempt
 Depression or other mood disorder
 Availability of a firearm
 Severe anxiety or panic attacks
 Family history of suicidal behavior
 Shame, humiliation, failure or rejection
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Fig. 18.10 Adolescent suicide rates vary for different racial and ethnic groups. Higher rates occur among
whites than among non-whites. White male adolescents run the highest risk of suicide. Considering
gender alone, it is apparent that more male than female adolescents commit suicide. This is the same as
the pattern observed for adults.
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Common Characteristics of Suicidal
Thoughts and Feelings (Page 605)
 Escape
 Unbearable Psychological Pain: Emotional
pain that the person wishes to escape
 Frustrated Psychological Needs: Such as
searching for love, achievement, or security
 Constriction of Options: Feeling helpless
and hopeless and deciding that death is the
only option left
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Fig. 16.16 Suicidal behavior usually progresses from suicidal thoughts, to threats, to attempts. A
person is unlikely to make an attempt without first making threats. Thus, suicide threats should
be taken seriously (Garland & Zigler, 1993).
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