Download Unit 12 and 13 Abnormal Psych and Treatments

Psychological Disorders
History of Mental Illness-Tedtalk
People are fascinated by the exceptional, the
unusual, and the abnormal. This fascination
may be caused by two reasons:
1.
During various moments we feel, think, and act
like an abnormal individual.
2.
Psychological disorders may bring unexplained
physical symptoms, irrational fears, and suicidal
thoughts.
Psychological Disorders
To study the abnormal is the best way of
understanding the normal.
William James (1842-1910)
1.
There are 450 million people suffering from
psychological disorders (WHO, 2004).
2.
Depression and schizophrenia exist in all cultures
of the world.
Deviant, Distressful & Dysfunctional
When behavior is deviant, distressful, and dysfunctional psychiatrists
and psychologists label it as disordered (Comer, 2004
Carol Beckwith
1. Deviant behavior
(going naked) in one
culture may be
considered normal,
while in others it may
lead to arrest.
2. Deviant behavior must
accompany distress.
3. If a behavior is
dysfunctional it is
clearly a disorder.
).
In the Wodaabe tribe men
wear costumes to attract
women. In Western society
this would be considered
abnormal.
The Biopsychosocial Approach
Assumes that biological, socio-cultural, and
psychological factors combine and interact to
produce psychological disorders.
Classifying Psychological Disorders
• Diagnostic and Statistical Manual
of Mental Disorders (DSM)
• International Classification of
Diseases (ICD-10)
• Criticisms of the DSM
Labeling Psychological Disorders:
Some psychologists criticize the use of labeling.
•
•
Critics of the DSM argue that labels may stigmatize
individuals.
Labels may become self-fulfilling.
Some psychologists find diagnostic labels useful.
•
Labels may be helpful for healthcare professionals
when communicating with one another and
establishing therapy.
Anxiety Disorders
Do I have an anxiety disorder?
Feelings of excessive apprehension and anxiety.
1.
2.
3.
4.
5.
Generalized anxiety disorder
Panic disorder
Phobias
Obsessive-compulsive disorder
Post-traumatic stress disorder
Generalized Anxiety Disorder
Symptoms
1. Persistent and uncontrollable tenseness and
apprehension.
2. Autonomic arousal.
3. Inability to identify or avoid the cause of
certain feelings, this is an anxiety which
Freud labeled free floating.
Panic Disorder
Symptoms
Minutes-long episodes of intense dread which may
include feelings of terror, chest pains, choking, or
other frightening sensations.
Anxiety is a component of both disorders. It
occurs more in the panic disorder, making
people avoid situations that cause it.
Smokers have at least doubled risk of panic
disorder.
Phobias
Marked by a persistent and irrational fear of an
object or situation that disrupts behavior.
Kinds of Phobias
Agoraphobia
Acrophobia
Claustrophobia
Phobia of open places.
Phobia of heights.
Phobia of closed spaces.
Hemophobia
Phobia of blood.
Social phobia
Shyness to an extreme
Obsessive-Compulsive Disorder
Howie Mandel on Obsessive Compulsive Disorder
Obsessive-Compulsive
Disorder
Persistence of unwanted thoughts (obsessions) and urges to
engage in senseless rituals (compulsions) that cause distress.
Brain Imaging
A PET scan of the brain of a person with
Obsessive-Compulsive Disorder (OCD). High
metabolic activity (red) in the frontal lobe areas are
involved with directing attention.
Post-Traumatic Stress Disorder
Four or more weeks of the following symptoms
constitute post-traumatic stress disorder
(PTSD):
1. Haunting memories
2. Nightmares
3. Social withdrawal
5. Sleep problems
Bettmann/ Corbis
4. Jumpy anxiety
Somatoform Disorders
• Symptoms mimic a physical disease or injury.
• Medical test results are either normal or do not
explain the person’s symptoms.
• One type of somatoform disorder is conversion
disorder in which very specific genuine physical
symptoms exist for which no physiological basis
can be found.
• Hypochondriasis is a somatoform disorder in
which a person interprets normal physical
sensations as symptoms of a disease.
Dissociative Disorders
Conscious awareness becomes separated
(dissociated) from previous memories, thoughts, and
feelings.
Symptoms
1. Having a sense of
being unreal.
2. Being separated from
the body.
3. Watching yourself as
if in a movie.
Dissociative Identity Disorder (DID)
Herschell Walker-Living with Dissociative
Disorder
A disorder in which a person exhibits two or
more distinct and alternating personalities,
formerly called multiple personality disorder.
Lois Bernstein/ Gamma Liason
3 Faces of Eve
Chris Sizemore (DID)
DID Critics
Critics argue that the diagnosis of DID
increased in the late 20th century. DID has
not been found in other countries.
Critics’ Arguments
1. Role-playing by people open to a
therapist’s suggestion.
2. Learned response that reinforces
reductions in anxiety.
Mood Disorders
Emotional extremes of mood disorders come in
two principal forms.
1. Major depressive disorder
2. Bipolar disorder
Vid Clip
Bipolar Disorder
Formerly called manic-depressive disorder. An
alternation between depression and mania
signals bipolar disorder.
Depressive Symptoms
Manic Symptoms
Gloomy
Elation
Withdrawn
Euphoria
Inability to make decisions
Tired
Slowness of thought
Desire for action
Hyperactive
Multiple ideas
Understanding Depressive
and Bipolar Disorders
• Many behavioral and cognitive changes
accompany depression
• Depression is widespread
• Women’s risk of major depression is nearly
double men’s
• Most major depressive episodes self-terminate
• Stressful events related to work, marriage and
close relationships often proceed depression
• With each new generation, depression is striking
earlier and affecting more people
Explaining Mood Disorders
Depression theories and treatments clip
Since depression is so prevalent worldwide,
investigators want to develop a theory of
depression that will suggest ways to treat it.
Lewinsohn et al., (1985, 1998) note that a theory
of depression should explain the following:
1. Behavioral and cognitive changes
2. Common causes of depression
The Depressed Brain
PET scans show that brain energy consumption
rises and falls with manic and depressive
episodes.
Courtesy of Lewis Baxter an Michael E.
Phelps, UCLA School of Medicine
Schizophrenia
The literal translation is “split mind” which
refers to a split from reality. A group of severe
disorders characterized by the following:
1. Disorganized and delusional
thinking.
2. Disturbed perceptions.
3. Inappropriate emotions and
actions.
Living with Schizophrenia Clip
Symptoms of Schizophrenia
Positive symptoms: the presence of
inappropriate behaviors
(hallucinations, disorganized or
delusional talking)
Negative symptoms: the absence of
appropriate behaviors (expressionless
faces, rigid bodies)
Patients with schizophrenia may
continually rub an arm, rock a chair, or
remain motionless for hours (catatonia).
A schizophrenic person may perceive
things that are not there (hallucinations).
Frequently such hallucinations are
auditory and lesser visual, somatosensory,
olfactory, or gustatory.
Understanding Schizophrenia
Schizophrenia is a disease of the brain exhibited
by the symptoms of the mind.
Dopamine Overactivity: Researchers found that
schizophrenic patients express higher levels of
dopamine D4 receptors in the brain.
Brain scans show abnormal activity in the
frontal cortex, thalamus, and amygdala of
schizophrenic patients.
Abnormal Brain Morphology
Schizophrenia patients may exhibit
morphological changes in the brain like
enlargement of fluid-filled ventricles.
Schizophrenia has also been observed in
individuals who contracted a viral
infection (flu) during the middle of their
fetal development.
DID V. Schizophrenia
Personality Disorders
Personality disorders
are characterized by
inflexible and
enduring behavior
patterns that impair
social functioning.
They are usually
without anxiety,
depression, or
delusions.
Vid Clip
Antisocial Personality Disorder
A disorder in which the person (usually men)
exhibits a lack of conscience for wrongdoing, even
toward friends and family members. Formerly,
this person was called a sociopath or psychopath.
Symptoms May Include:
• Lack of empathy or affection.
• No regard for right and wrong.
• Using charm or wit to manipulate others.
• Intimidation of others.
•Violent or aggressive behavior.
Understanding Antisocial
Personality Disorder
Like mood disorders
and schizophrenia,
antisocial personality
disorder has biological
and psychological
reasons. Youngsters,
before committing a
crime, respond with
lower levels of stress
hormones than others
do at their age.
Understanding Antisocial
Personality Disorder
PET scans of 41 murderers revealed reduced
activity in the frontal lobes. In a follow-up study,
repeat offenders had 11% less frontal lobe activity
(Raine et al., 1999; 2000).
Courtesy of Adrian Raine,
University of Southern California
Normal
Murderer
Case Study Work
History of Insane Treatment
Maltreatment of the
insane throughout the
ages was the result of
irrational views. Many
patients were
subjected to strange,
debilitating, and
downright dangerous
treatments.
Philippe Pinel in France and Dorthea Dix
in America founded humane movements
to care for the mentally sick.
The Granger Collection
Philippe Pinel (1745-1826)
Psychological Therapies
We will look at four major forms of
psychotherapies based on different theories of
human nature:
1.
2.
3.
4.
Psychoanalytic theory
Humanistic theory
Behavioral theory
Cognitive theory
Psychoanalysis
The first formal psychotherapy
to emerge was psychoanalysis,
developed by Sigmund Freud.
Free association
The patient lies on a couch and
speaks about whatever comes to his
or her mind.
• AIMS:
• Since psychological problems originat
from childhood repressed impulses an
conflicts
• bring repressed feelings into consciou
awareness where the patient can dea
with them.
• When energy devoted to id-egosuperego conflicts is released, the
patient’s anxiety lessens.
Sigmund Freud's famous couch
Psychoanalysis: Methods
Free Association
During free association, the patient edits his
thoughts, resisting his or her feelings to express
emotions. Such resistance becomes important in
the analysis of conflict-driven anxiety.
Eventually the patient opens up and reveals his
or her innermost private thoughts, developing
positive or negative feelings (transference)
towards the therapist.
Psychoanalysis: Criticisms
1. Psychoanalysis is hard to refute because it
cannot be proven or disproven.
2. Psychoanalysis takes a long time and is very
expensive.
Humanistic Therapies
Humanistic therapists aim to boost self-fulfillment by
helping people grow in self-awareness and selfacceptance. Psychoanalytic and humanistic therapies
are referred to as insight theories, but humanistic
therapies focus on:
 the past and present, more than the past.
 conscious, rather than unconscious feelings.
 taking immediate responsibility for one’s feelings and
actions, rather than uncovering hidden determinants.
 promoting growth, rather than curing illness.
Client-Centered Therapy
Developed by Carl Rogers, client-centered
therapy is a form of humanistic therapy.
The therapist listens to the needs of the patient
in an accepting and non-judgmental way,
addressing problems in a productive way and
building his or her self-esteem.
Rogers interview
Example of client
centered
Behavior Therapy
• Therapy that applies learning principles to
the elimination of unwanted behaviors.
• Counterconditioning is a procedure that
conditions new responses to stimuli that
trigger unwanted behaviors.
• It is based on classical conditioning and
includes exposure therapy (systematic
desensitization) and aversive
conditioning.
Exposure Therapy
The Far Side © 1986 FARWORKS. Reprinted with Permission. All Rights Reserved.
Expose patients to
things they fear and
avoid. Through
repeated exposures,
anxiety lessens because
they habituate to the
things feared.
Exposure therapy
involves exposing
people to fear-driving
objects in real or virtual
environments.
Aversive Conditioning
A type of
counterconditioning
that associates an
unpleasant state with
an unwanted behavior.
With this technique,
temporary
conditioned aversion
to alcohol has been
reported.
Operant Conditioning
• Operant conditioning procedures enable
therapists to use behavior modification, in
which desired behaviors are rewarded and
undesired behaviors are either unrewarded or
punished.
• A number of withdrawn, uncommunicative
3-year-old autistic children have been
successfully trained by giving and
withdrawing reinforcements for desired and
undesired behaviors.
Cognitive Therapy
• Teaches people adaptive ways of thinking and acting based on the
assumption that thoughts intervene between events and our
emotional reactions.
• Cognitive-behavior therapy aims to alter the way people act
(behavior therapy) and alter the way they think (cognitive
therapy).
Beck’s Therapy for Depression
• Aaron Beck (1979) suggests that depressed
patients believe that they can never be happy
(thinking) and thus associate minor failings
(e.g. failing a test [event]) in life as major
causes for their depression.
• Beck believes that cognitions such as “I can
never be happy” need to change in order for
depressed patients to recover. This change is
brought about by gently questioning patients.
The Relative Effectiveness of
Different Therapies
Which psychotherapy would be most effective
for treating a particular problem?
Disorder
Therapy
Depression
Behavior, Cognition, Interpersonal
Anxiety
Cognition, Exposure, Stress Inoculation
Bulimia
Cognitive-behavior
Phobia
Behavior
Bed Wetting
Behavior Modification
Is Psychotherapy Effective?
It is difficult to gauge the effectiveness of
psychotherapy because there are different levels
upon which its effectiveness can be measured.
1.
2.
3.
Does the patient sense improvement?
Does the therapist feel the patient has improved?
How do friends and family feel about the
patient’s improvement?
Outcome Research
How can we objectively measure the
effectiveness of psychotherapy?
Meta-analysis of a number of studies suggests
that thousands of patients benefit more from
therapy than those who did not go to therapy.
The Biomedical Therapies
These include physical, medicinal, and other
forms of biological therapies.
1. Drug Therapies
2. Brain Stimulation
3. Psychosurgery
Drug Therapies
Psychopharmacology is the study of drug effects
on mind and behavior.
With the advent of drugs, hospitalization in mental
institutions has rapidly declined.
Antipsychotic Drugs
Classical antipsychotics [chlorpromazine
(Thorazine)]: Remove a number of positive
symptoms associated with schizophrenia such
as agitation, delusions, and hallucinations.
Atypical antipsychotics [clozapine (Clozaril)]:
Remove negative symptoms associated with
schizophrenia such as apathy, jumbled thoughts,
concentration difficulties, and difficulties in
interacting with others.
Atypical Antipsychotic
Clozapine (Clozaril) blocks receptors for
dopamine and serotonin to remove the negative
symptoms of schizophrenia.
Antianxiety Drugs
Antianxiety drugs (Xanax and Ativan) depress the
central nervous system and reduce anxiety and tension
by elevating the levels of the Gamma-aminobutyric acid
(GABA) neurotransmitter.
Antidepressant Drugs
Medicine and Psychotherapy
Antidepressant drugs like Prozac, Zoloft, and Paxil are
Selective Serotonin Reuptake Inhibitors (SSRIs) that
improve the mood by elevating levels of serotonin by
inhibiting reuptake.
Mood-Stabilizing Medications
Lithium Carbonate, a common salt, has been used
to stabilize manic episodes in bipolar disorders. It
moderates the levels of norepinephrine and
glutamate neurotransmitters.
Brain Stimulation
Electroconvulsive Therapy
(ECT)
ECT is used for severely
depressed patients who do
not respond to drugs. The
patient is anesthetized and
given a muscle relaxant.
Patients usually get a 100
volt shock that relieves
them of depression.
Psychosurgery
Psychosurgery is used as a last resort in
alleviating psychological disturbances.
Psychosurgery is irreversible. Removal of brain
tissue changes the mind.