Download Chapter 12 - Abnormal Psychology

Abnormal Psychology
The diagnosis and treatment of
mental disorders
Criteria for disordered behavior
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Distress
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Deviance
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Is their behavior outside of what is culturally normal?
Dysfunction
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Are they upset about their behavior?
Does their behavior interfere with or impair daily
functioning? Do they have a job? Normal
relationships?
Danger
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To themselves or others; made threats to harm
themselves or harm others
History of mental illness
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People presumed that maladaptive behavior was due to:
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Lunar cycles (“full moon brings out the crazy”)
Evil spirits (possession)
People with god-like powers (witches)
Placed great emphasis on exorcising demons
“Therapies” included:
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Beatings
Burnings
Castration
Pulling teeth
“Cauterizing” or burning of the clitoris
Transfusions of animal blood or removal of ones own blood to
restore “a balance of the humors”
History of Mental Illness
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Medical model- the assumption that mental
illness is a sickness
Mental illness is diagnosed by its symptoms and
cured through therapy which may or may not
include treatment in a psychiatric hospital
More recently the field of psychology has moved
towards the medical perspective because?????
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Cant argue genetics/biology. It’s a natural science
with LAWS instead of THEORIES which are
debatable and subject to interpretation
Bio-psycho-social Approach
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Disordered behavior is a combination of
various factors that stem from:
Genetic predisposition (Bio)
 Stress, trauma, environ. issues (psycho)
 Social expect., norms, environ. issues (social)
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Stress, Trauma,
Environmental issues
(Psychological)
Genetic
Predisposition
(Biological)
Bio Psycho Sociological
Approach
Social expect.,
norms,
environ. Issues
(sociological)
Classifying Psychological Disorders
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DSM IV TR
 Diagnostic Statistical Manual of Mental
Disorders 4th ed. (text revision)
Benefits of diagnostic labeling include:
 A uniform method of identifying/classifying
maladaptive behavior
 Introduces a homogenized method of
effective treatment
 Encourages appropriate research to identify
causality
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Critics of the DSM IV TR and diagnostic
labeling cite:
DSM views almost every behavior as
abnormal in some capacity
 Leads to over/misdiagnosis of “normal”
people
 Stigmatizing power of labels
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 Perceive
people differently that have been
diagnosed with a mental disorder
 Instead of perceiving mental illness as a disease of
the brain its viewed as a fault in character
 Diagnostic labeling can also alter reality in that the
“victim” becomes a self-fulfilling prophesy
Schizophrenia
Schizophrenia
Out of touch with reality
 Two or more of the following during a one
month period
 Positive Symptoms (an ADDITION to your
sensory experience)
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Delusions
 Hallucinations
 Disorganized speech
 Disorganized or catatonic behavior
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Negative Symptoms
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Negative Symptoms (a LOSS or defect of
your sensory experience)
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Alogia
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Flat affect
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Show little to no emotions
Avolition
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Decrease in speech or speech content (empty or absent
replies)
Apathy or feeling drained of energy
Social withdrawal
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Distancing oneself from their environment and becoming
preoccupied with their ideas and fantasies
Schizophrenia
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The onset of schizophrenia usually happens
in late adolescence and in the early 20’s
1% of the population is schizophrenic
More positive symptoms Type I
More negative symptoms Type II
Males tend to get it earlier; gender ratio is 1:1
Drug use can “spark” schizophrenia;
especially hallucinogens
Pathology
Enlarged brain ventricles,
underdeveloped frontal area of the
brain (mostly Type II)
 Excessive sensitivity to dopamine
 Prenatal exposure to influenza virus
during the second trimester of
pregnancy
 Overwhelming biological evidence
linking schizophrenia
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Types of Schizophrenia
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Catatonic schizophrenia
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Paranoid schizophrenia
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More delusions than anything else
Disorganized schizophrenia
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More catatonic behavior than anything else
More disorganized speech than anything else
Undifferentiated schizophrenia
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Waste bin of schizophrenia
Delusions
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Delusions are false beliefs
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Delusions of persecution
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Delusions of reference
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Assumptions that outside stimuli is being sent to you about
ways to live your life
Delusions of control
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Threats of harm from someone
Assume others are controlling you through some form of
telepathy
Delusions of grandeur
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Thoughts that you are an important person or figure ex.
Hitler, Satan, Jesus, Virgin Mary, etc.
Disorganized Speech
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Neologism
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Perseveration
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Made up words ex. hexklemp
Saying the same word over and over
Clanging
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Rhyming words into an incoherent phrase
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Word salad
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“He raged at the hypocrisy of aristocracy democracy!!”
Tossing words in randomly; jibberish
Loose associations
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Bouncing from one topic of conversation in an
incoherent fashion
Hallucinations
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Hallucinations are false perceptions within
your senses
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Auditory hallucinations are by far the most common
 Hear sounds and voices that come from outside their heads
 Auditory hallucinations are most likely to occur during times of
idleness or inattention
Visual hallucinations
 Vague perceptions of color; seeing people or objects that aren’t
there
Tactile hallucinations
 Tingling, burning, electrical shock sensations, or bugs crawling all
over one’s body or beneath the skin
Somatic hallucinations
 An organ shifting inside the body or a snake inside one’s stomach
Catatonic behavior
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Catatonic stupor
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Catatonic rigidity
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Maintaining rigid, upright posture for hours and
resisting efforts to be moved
Catatonic posturing
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Totally unaware of and unresponsive to their
environment
Assuming awkward bizarre positions for long periods
of time
Catatonic excitement
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Hyperactivity, uncontrollable wild behavior; wildly
waving arms and legs
Treatments for Schizophrenia
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Electroconvulsive Therapy (ECT)
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Patient is shocked with up to 100 volts of electricity
SIDE EFFECTS: memory loss, extremely painful,
clinicians don’t know why it works
Convulsive Therapy
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Drugs are administered to cause a seizure to “re
start” the brain ending hallucinations and delusions
SIDE EFFECTS: clinicians don’t know why it works,
kidney and liver damage
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Phenothiazines (Anti psychotic medication)
Haldol, Thorazine, Mellaril
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A derivative of antihistamines; diminish positive
symptoms and negative symptoms with time
SIDE EFFECTS: tardive dyskinesia (uncontrollable
shaking), dystonia (involuntary muscle contractions,
uncontrollable movement of the face, neck, &
tongue), diminished sexual activity, nausea
Bipolar Disorder
Bipolar Disorder
Mania
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Mania- a distinct period of abnormally elevated
mood, lasting at least 1 week
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3 or more of the following
Inflated self esteem
Decreased need for sleep
More talkative than usual
A flight of ideas or thoughts are racing
Excessive involvement in pleasurable activities that
have a high potential for painful consequences (ex.
Excessive gambling)
Maniacs tend to be hypersexual or drink to come
down from a manic episode
Men tend to present as manic; females present as
depressive and have more dep. Episodes, men =
Depression
• 5 or more of the following in a 2 wk period
– Depressed mood most of the day nearly every
day
– Diminished interest
– Significant weight loss or decrease in appetite
– Insomnia or loss of energy
– Feelings of worthlessness or excessive guilt
– Recurrent thoughts of death or suicide
Treatments
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Lithium to delay or prevent episodes of mania
and depression
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SIDE EFFECTS: Nausea, impaired kidney
function, vertigo, muscle weakness
For 20-40% of manic depressives lithium
doesn’t work so we treat the mania (anti
convulsives) and depression (anti
depressants) separately
Bipolar Disorder
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Whites tend to be more at risk than minorities
Native Americans also have a higher risk than other
minorities
1% of the population is manic depressive
Effects men and women equally
15% commit suicide
Artists, writers, poets and musicians show a higher
incidence of manic depression
Strong genetic link; tends to run in families
Anxiety Disorders
• Most common disorders in the US
• 15-17% of the US population suffer
– Generalized Anxiety Disorder
– Phobia
– Panic disorder
– Obsessive Compulsive Disorder
– Post Traumatic stress Disorder
– Social Anxiety Disorder
Generalized Anxiety Disorder
• Excessive anxiety or worrying about
numerous events or activities
• Sufferers live in a constant state of fear
and dread
• Women outnumber men 2:1
• Typically called “worriers”
Symptoms
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Restlessness
Fatigue
Difficulty concentrating
Irritability
Muscle tension
Insomnia
GAD
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As job income decreases the incidence
of GAD increases
SSRI’s (Select Serotonin Reuptake
Inhibitors) are the most common
treatment
– Prozac
– Paxil
– Zoloft
Phobia
A persistent unreasonable fear of
particular objects, activities, or
situations
Phobia
• Are different from everyday fears
• Phobic fear is more intense and persistent
• The desire to avoid the object or situation
is more compelling (stronger)
• Phobic fear interferes with personal,
social, and occupational functioning
Phobia
• DSM IV criteria
– Marked and persistent fear that is excessive or
unreasonable. Cued or caused by the presence
or anticipation of the specific object or
situation
– Exposure to the phobic stimulus provokes an
immediate response
– The person recognizes that the fear is
unreasonable
– Avoidance, anxious anticipation or distress
interferes with normal functioning
Phobia
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10-15 million in the US suffer
The most common phobias fall into 1 of 5
categories or FAMILIES
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Blood born or injection
Animal
Natural environment
Situational
other
Phobia
2:1 female to male
 The earlier the onset the easier to cure
 Tends to run in families
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Treatments
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Flooding
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Systematic Desensitization
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Forcing a subject to come in contact with the phobic
stimulus
Slowly exposing the subject to the phobic stimulus to
extinguish the fear
High risk for re-traumatization with flooding; but
its quicker
Systematic Desensitization takes more time