Download The Psychological Disorders

The Psychological Disorders
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Abnormal means not of the norm or not
average
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Lebron James
Einstein
What is abnormal for psychologists?
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Refers to maladaptive cognitions, affects,
and or behaviors that are at odds with
social expectations and result in distress or
discomfort
Abnormal
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The reactions of people with psychological disorders are
maladaptive
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May present itself in various ways
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Affect
Behavior
Cognition
Social factors are also important
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They must be impaired somehow
Not just strange
Behavior at a party vs. school
Distressing
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Psychological disorders are uncomfortable for those that have one
as well as those around them
Diagnostic Statistical Manual
of Mental Disorders (DSM)
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A way to classify and diagnose mental
disorders.
Lists 297 different diagnostic categories
Does not attempt to address the causes
of mental disorders
It is an attempt to be as objective as
possible in describing the symptoms of
mental disorders
Anxiety Disorders, Somatoform
Disorders, and Dissociative
Disorders
Anxiety Disorders
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Definition of anxiety
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A feeling of general apprehension or dread
accompanied by predictable physiological changes
Two levels
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Subjective feelings
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Dread
Fear
Physiological responses
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Increased muscle tension
Shallow rapid breathing
Increased perspiration
Drying of the mouth
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Sympathetic response
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Anxiety Disorders
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Major symptom of anxiety
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Feeling of anxiety coupled with avoidance
behavior
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Most common of all the psychological
disorders
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Attempt to avoid situations that seems to produce
anxiety
Perhaps as many as 25-30% of people will
experience an anxiety disorder at some time in
their lives.
more common in women
Five anxiety disorders
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1) Generalized anxiety disorder (GAD)
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Unrealistic, excessive, persistent worry
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Chronic
An intense anxiety that is diffuse
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Not brought on by anything specific
No clear insight to what is causing the anxiety
2) Panic Disorder
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Recurrent, unpredictable, unprovoked onset of sudden,
intense anxiety.
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Can last from seconds to hours
No particular stimulus to bring it on
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More acute than GAD
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1.5-3.5% of the population
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Age of onset is adolescence to mid twenties
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Initial attacks are often associated with stress
Often accompanied with depression
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comorbid
High rate of suicide attempts – 20 %
3) Phobic Disorders
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A persistent and excessive fear of some object, activity, or
situation that consistently leads a person to avoid it.
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No real or significant threat involved
The fear is unreasonable
Two main categories of phobic disorders
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Specific Phobias
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Animals
Physical environment – storms, heights
Blood, injection, or injury
Specific situations – tunnels, airplanes
Social phobias
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Persistent fears of social or performance situations in which
embarrassment could occur
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Public speaking
4) Obsessive-Compulsive
Disorder (OCD)
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A pattern of recurrent obsessions and compulsions
Obsessions
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Ideas or thoughts that involuntarily and constantly intrude
into awareness
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Cleanliness, violence, disease, danger, doubt
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Compulsions
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Constantly intruding, repetitive behaviors
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Did I turn off the stove?
Handwashing, grooming, counting, and checking
Checking your alarm repeatedly to make sure it is set
Video
Posttraumatic Stress Disorder
(PTSD)
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Distressing symptoms that arise some time
after the experience of a highly traumatic
event
Trauma as defined by the DSM-IV
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The person has experienced, witnessed, or been
confronted with an event that involves actual or
threatened death or serious injury
The person’s response involves intense fear,
helplessness, or horror.
Symptoms of PTSD
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Re-experiencing the traumatic event
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Avoidance of any possible reminders of the
event
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Flashbacks
Nightmares
People who were there
Increased arousal or alertness
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Irritability
Insomnia
Difficulty concentrating
Somatoform Disorders
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Disorders that involve some physical,
bodily complaint
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Psychological disorders
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No known medical or biological cause for the
symptoms.
Three types
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Hypochondriasis
Somatization disorder
Conversion disorder
Hypochondriasis and
Somatization Disorders
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hypochondriasis
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somatization disorder
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Fear of a nonexistent disease
preoccupied with nonexistent symptoms
Really the two disorders are quite similar
Conversion Disorder
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Loss or altering of physical function that
suggests that there is some physical problem
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Paralysis – often times of just the hand
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Glove anesthesia
Blindness
Deafness
This was Freud’s Hysteria
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Diagnosed much more often in Freud’s time
Dissociative Disorders
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To dissociate means to become separate or
escape
Dissociative amnesia
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Inability to recall important personal information
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Beyond simple forgetfulness
Often times it involves forgetting some traumatic
event
Somewhat controversial disorder
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Like repressed memories
Dissociative Identity Disorder
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Multiple personality disorder
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Not schizophrenia – which we will talk about later
The existence within the same person of two
or more distinct personalities.
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Used to be very rare (but became more common
since 1970s)
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Most recorded cases are restricted to North America
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Rare in France, England, Russia, and India
 None in Japan?
Usually this disorder occurs in patients working
closely with a therapist
Personality Disorders
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These disorders represent stable
abnormal personality characteristics
that people are born with and are
difficult to treat.
What is a Personality
Disorder?
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Personality disorder- an enduring pattern of
inner experience and behavior that:
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deviates markedly from the expectation of the
individual’s culture
Is pervasive and inflexible
Has an onset in adolescence or early adulthood
Is stable over time
Leads to distress or impairment
What is Impaired?
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To be diagnosed with a personality
disorder, one must exhibit behavior that
is abnormal with respect to any two of
the following:
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Thinking
Mood
Personal relations
The control of impulses
The DSM’s 3 Clusters of
Personality Disorders
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Cluster A - Odd or Eccentric
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Cluster B- Dramatic, Emotional, or Erratic
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(paranoid, schizoid, schizotypal)
(antisocial, borderline, histrionic, narcissistic)
Cluster C- Anxious or Fearful
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(avoidant, dependent, obsessive-compulsive)
Cluster A
Paranoid
Schizoid
Schizotypal
Paranoid
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Distrust of others, including the belief,
without reason, that others are
exploiting, harming, or trying to deceive
them
Belief in hidden meanings
Unforgiving and grudge holding
Schizoid
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Very limited range of emotion, both in
expression of and experiencing
Indifferent to social relationships
Prefer solitary interests
Schizotypal
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Peculiarities of thinking
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Odd beliefs (e.g.- belief that they have
telepathic or magical powers)
Eccentricities of appearance, behavior,
interpersonal style, and thought (e.g.“I am not a very talkable person”)
Cluster B
Antisocial
Borderline
Histrionic
Narcissistic
Antisocial
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Lack of regard for the moral or legal
standards in the local culture
Inability to get along with others or
abide by societal rules
Sometimes called “psychopaths” or
“sociopaths”
Borderline
•Instability in affect and self-image
•Problems with self-identity
•Rapid changes in mood
•Intense unstable relationships
•Impulsivity
Histrionic
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Overly dramatic and attention seeking
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Exaggerated or inappropriate displays of
emotional reactions
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theatrical
Unusual clothing, hairstyle, or makeup used to
draw attention to themselves
Overly concerned with their physical
attractiveness and are uncomfortable when
they are not the center of attention
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Jenna on 30 Rock
Narcissistic
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Behavior or a fantasy of grandiosity
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A need to be admired by others
Inability to see the viewpoints of others
Relationships are disturbed because of
their lack of empathy and feelings of
envy, arrogance, and taking advantage
of others
Hypersensitive to the opinions of others
Cluster C
Avoidant
Dependent
Obsessive-Compulsive
Avoidant
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Social inhibition
Feelings of inadequacy
Extremely sensitive to criticism
Dependent
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Extreme need of other people
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unable to make any decisions or take an
independent stand on their own
Fear of separation and submissive
behavior
Lack self-confidence
Obsessive-Compulsive
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Perfectionism
Inflexibility
Obsessive-compulsive personality
disorder is NOT the same as obsessivecompulsive disorder
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No actual obsessions or compulsions
Alzheimer’s Dementia, Mood
Disorders, and Schizophrenia
Alzheimer's Disease
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How many get it?
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15% of people over 65
35% over 85
First signs?
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Decline in cognitive ability
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forgetfulness
Emotional instability
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depression
Alzheimer’s
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Eventually
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Total dementia
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swallowing
Terminal
Definitively diagnosed by autopsy
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Amyloid plaques
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Neurofibrillary tangles
Alzheimer's Disease
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Loss of neurons is common
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Hippocampus
Amygdala
entorhinal cortex
Alzheimer’s Disease
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genetic component
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If immediate family member
 50% chance if live into 80’s
Cholinergic neurons
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Cholinergic agonists
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Many don’t respond
Transgenic mouse
Mood Disorders
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affective disorders
disturbance of the mood is the defining
symptom
Symptoms and Etiology
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All of us have experienced depression
people in whom depression is so severe and so
frequent, often without obvious cause, are said to
be suffering from the psychiatric disorder of
depression
Depression is characterized by
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Despair
Hypoactivity
sleep problems
Withdrawal
lack of appetite
an inability to care for oneself
Mania
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opposite of depression
 overconfident, impulsive, distractible and highly
energetic
Many people who suffer from depression also
suffer from mania
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bipolar disorder (1% of people)
unipolar disorder (6% of people)
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depression only
About 10% of people suffering from a mood
disorder will commit suicide
Diathesis /Stress model
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Concordance rate for bipolar disorder
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identical twins about 60%
fraternal twins about 15%
thus, there is a strong genetic component
Stress can play a major role
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84% experienced a severe stress in the preceding year
Antidepressant Drugs
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monoamine oxidase (MAO) inhibitors
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Tricyclic Antidepressants
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Selective serotonin reuptake inhibitors (SSRIs)
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Prozac
Recently, serotonin -norepinephrine reuptake inhibitors
(SNRIs) have proven equally effective in the treatment of
depression
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Effexor
Cymbalta
Monoamine Theory of
Depression
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Most widely accepted theory of
depression
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All the drugs are serotonin and/or
norepinephrine agonists
Depression due to underactivity at
serotonin and norepinephrine synapses?
Schizophrenia
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Symptoms and Etiology
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schizophrenia literally means a splitting
of psychic function (“the shattered mind”)
characterized by a complex and diverse set
of symptoms
Positive vs. Negative
Symptoms
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Positive
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Hallucinations
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Delusions
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False Perceptions
False Beliefs
Bizarre Behaviors
Negative
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Emotional and social withdrawal
Reduced energy and motivation
Apathy
Poor attention
types of Schizophrenia
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Paranoid
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presence of auditory hallucinations
prominant delusional thoughts about
persecution or conspiracy
often function well, and symptoms may not
present until later in life
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beautiful mind
Disorganized schizophrenia
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disorganization of thought process
hallucinations and delusions less pronounced
significant impairment in ability to maintain
everyday activities
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dressing, bathing, brushing teeth
disrupted emotions
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flattened affect
inappropriate emotions
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laughing at funeral
catatonic schizophrenia
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disturbance in movement
catatonic stupor
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catatonic excitement
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resist any attempt to move them
may hold any position in which they are placed
may voluntarily choose a contorted body position and stay that way
for long periods of time
echolilia
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increased movement
may become immobile
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voluntary movement stops
mimic what people say
echopraxia
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mimic what people do
Undifferentiated and Residual
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Undifferentiated
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Residual
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catch all
this is the diagnosis when not easily classified
into the other subtypes
diagnosed when patient is no longer displaying
prominent symptoms
some patients wax and wan though varying
degrees of illness
Video
Cause of Schizophrenia?
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About 1% of the population is
schizophrenic
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the incidence appears to be about the
same in all parts of the world
A genetic basis
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the concordance rate of schizophrenia in
identical twins is about 45%
in fraternal twins or sibs it is about 10%
Cause of Schizophrenia?
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Experiential Factors
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prenatal trauma
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Nutritional deficiency
Infection
stress
Clearly schizophrenia is influenced by both
genetics and experience
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the current view is that people inherit a
predisposition for schizophrenia which may or
may not be activated by experience
Dopamine Theory of
Schizophrenia
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Chlorpromazine and Reserpine
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quite different from each other in terms of
chemical structure
Effects were very similar
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Didn’t start working for 2 or 3 weeks
Both drugs started to produce side effects
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mild tremors at rest
muscular rigidity
a decrease in voluntary movement
symptoms of Parkinson's disease
Dopamine Hypothesis
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Parkinson’s patients have a deficiency of dopamine in
their brains
Looks like chlorpromazine and reserpine reduce brain
dopamine levels
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Creating parkinson’s like symptoms
But alleviating symptoms of schizophrenia
Thus - It was proposed that schizophrenia is
associated with excessive activity in
dopaminergic systems in the brain