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Download Unit 12 and 13 Abnormal Psych and Treatments
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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.