Download Chapter 16

PSYCHOLOGY
(8th Edition)
David Myers
PowerPoint Slides
Aneeq Ahmad
Henderson State University
Worth Publishers, © 2006
1
Psychological Disorders
Chapter 16
2
Psychological Disorders
Perspectives on Psychological
Disorders
 Defining Psychological Disorders
 Understanding Psychological
Disorders
 Classifying Psychological Disorders
 Labeling Psychological Disorders
3
Psychological Disorders
Anxiety Disorders
 Generalized Anxiety Disorder and
Panic Disorder
 Phobias
 Obsessive-Compulsive Disorders
 Post-Traumatic Stress Disorders
 Anxiety Disorder Explanation
4
Psychological Disorders
Mood Disorders
 Major Depressive Disorders
 Bipolar Disorder
 Mood Disorder Explanation
Schizophrenia
 Symptoms of Schizophrenia
 Subtypes of Schizophrenia
5
Psychological Disorders
Schizophrenia
 Understanding Schizophrenia
Personality Disorders
Rates of Psychological
Disorders
6
Psychological Disorders
I felt the need to clean my room … spent four to five
hour at it … At the time I loved it but then didn't want
to do it any more, but could not stop … The clothes
hung … two fingers apart …I touched my bedroom
wall before leaving the house … I had constant anxiety
… I thought I might be nuts.
Marc, diagnosed with
obsessive-compulsive disorder
(from Summers, 1996)
7
Psychological Disorders
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.
8
World Health Organization
Do we see something of ourselves? It’s no wonder then that
studying psychological disorders may at times evoke an eerie
sense of self-recognition.
Some 450 million people worldwide suffer from psychological
disorders according to the World Health Organization
(WHO). One in four people in the world will be affected by
mental or neurological disorders at some point in their lives.
This places mental disorders among the leading
causes of ill-health and disability worldwide.
9
What is Abnormal?
So where should we draw the line
between sadness and depression?
How do we determine between
zany creativity and bizarre irrationality?
• How should we define psychological disorders?
• How should we understand disorders-as a sickness or as a
natural response to a sick environment?
• How should we classify psychological disorders?
10
Defining Psychological Disorders
Mental health workers view psychological
disorders as persistently harmful thoughts,
feelings, and actions.
When behavior is deviant, distressful, and
dysfunctional psychiatrists and psychologists
label it as disordered (Comer, 2004).
11
Deviant, Distressful & Dysfunctional
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.
12
Psychological disorders consist of deviant,
distressful, and dysfunctional
behavior patterns.
1) Deviant- being different from most other
people in
one’s culture. Deviance can also vary with culture,
context and time.
2) Distressful- causing discomfort
3) Dysfunctional- the inability to live your life or
fulfill your role in life
13
Understanding Psychological
Disorders
Ancient Treatments of psychological disorders
include trephination, exorcism, being caged like
animals, being beaten, burned, castrated,
mutilated, or transfused with animal’s blood.
John W. Verano
Trephination (boring holes in the skull to remove evil forces)
14
Medical Perspective
Philippe Pinel (1745-1826) from France, insisted
that madness was not due to demonic possession,
but an ailment of the mind.
George Wesley Bellows, Dancer in a Madhouse, 1907. © 1997 The Art Institute of Chicago
Dance in the madhouse.
Can you test
for mental
illness?
15
Medical Model
PET Scan of Sociopaths
When physicians discovered that syphilis led to
mental disorders, they started using medical models
to review the physical causes of these disorders.
1.
2.
3.
4.
Etiology: Cause and development of the
disorder.
Diagnosis: Identifying (symptoms) and
distinguishing one disease from another.
Treatment: Treating a disorder in a psychiatric
hospital.
Prognosis: Forecast about the disorder.
16
Biopsychosocial Perspective
Assumes that biological, socio-cultural, and
psychological factors combine and interact to
produce psychological disorders.
17
The Biopsychological Approach
Psychologists who reject the “sickness” idea typically
contend that all behavior arises from the interaction
of nature (genetic and physiological factors) and
nurture (past and present experiences).
Critics argue that psychological disorders may not
reflect a deep internal problem but instead a growthblocking difficulty in the person’s environment, in
the person’s current interpretation of events, or in the
person’s bad habits and poor social skills.
18
The biopsychosocial approach assumes that
disorders are influenced by genetic factors,
physiological states, inner psychological dynamics,
and social and cultural circumstances.
19
Classifying Psychological Disorders
The American Psychiatric Association rendered
a Diagnostic and Statistical Manual of Mental
Disorders (DSM) to describe psychological
disorders.
The most recent edition, 2013, describes 400
psychological disorders compared to 60 in the
1950s.
20
The reliability of the classification is high.
Two clinicians working independently applying the
guidelines are likely to reach the same diagnosis.
DSM diagnoses are developed in coordination with
the International Classification of Diseases (ICD).
Most health insurance policies in North America
require an ICD diagnosis before they will pay for
therapy.
As a complement to the DSM, some psychologists are
offering a manual of human strengths and virtues
(the “un-DSM”).
21
See the close-up on page 646.
Multiaxial Classification
Axis I
Axis II
Is a Clinical Syndrome (cognitive, anxiety,
mood disorders [16 syndromes]) present?
Is a Personality Disorder or Mental Retardation
present?
Is a General Medical Condition (diabetes,
Axis III
hypertension or arthritis etc) also present?
Are Psychosocial or Environmental Problems
Axis IV
(school or housing issues) also present?
What is the Global Assessment of the person’s
Axis V functioning?
22
Multiaxial Classification
Note 16 syndromes in Axis I
23
Multiaxial Classification
Note Global Assessment for Axis V
24
Goals of DSM
1.
2.
Describe (400) disorders.
Determine how prevalent the
disorder is.
Disorders outlined by DSM-V are reliable.
Therefore, diagnoses by different professionals
are similar.
Others criticize DSM-V for “putting any kind of
behavior within the compass of psychiatry.”
25
Labeling Psychological Disorders
1. Critics of the DSM-V argue that labels may
stigmatize individuals.
Elizabeth Eckert, Middletown, NY. From L. Gamwell and
N. Tomes, Madness in America, 1995. Cornell University Press.
Asylum baseball team (labeling)
26
Labeling Psychological Disorders
2. Labels may be helpful for healthcare
professionals when communicating with
one another and establishing therapy.
27
Critics point out that labels can create
pre-conceptions that bias our perceptions of
people’s past and present behavior and unfairly
stigmatize these individuals.
Labels can also serve as self-fulfilling prophecies.
Not only can labels bias perceptions,
they can also change reality.
When we expect someone to behave in a certain way,
they may act in ways that elicit
the very behavior expected.
28
Labeling Psychological Disorders
Elaine Thompson/ AP Photo
3. “Insanity” labels
raise moral and
ethical questions
about how society
should treat people
who have
disorders and have
committed crimes.
Theodore Kaczynski
(Unabomber)
29
Diagnostic labels help not only to describe a
psychological disorder but to predict its future course,
to imply appropriate treatment, and to stimulate
research into its possible causes.
The label of “insanity” raises moral and ethical
questions about how people should treat people who
have disorders and have committed crimes.
At least 9 in 10 people with disorders are not
dangerous; instead anxious, depressed, or
withdrawn.
See Thinking critically about the Insanity Plea.
See Larry Robinson. WOW!
30
Anxiety Disorders
Feelings of excessive apprehension and anxiety.
1.
2.
3.
4.
5.
Generalized anxiety disorders (GAD)
Phobias
Panic disorders
Obsessive-compulsive disorders (OCD)
Post traumatic stress disorder (PTSD)
31
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.
32
Generalized anxiety disorder is an anxiety
disorder in which a person is:
* Continually tense
* Apprehensive worried about various bad things
might happen
* plagued by muscular tension
* Agitated
*Suffer from sleeplessness
Explanation of GAD
33
Panic Disorder
Symptoms
Minute-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.
34
Phobia
Marked by a persistent and irrational fear of an
object or situation that disrupts behavior.
How a Fear becomes a Phobia
35
Kinds of Phobias
Agoraphobia
Acrophobia
Claustrophobia
Hemophobia
Phobia of open places.
Phobia of heights.
Phobia of closed spaces.
Phobia of blood.
36
Phobias
In contrast to the normal fears we all
experience, phobias can be so severe
that they are incapacitating.
For example, social anxiety disorder,
an intense fear of being scrutinized by
others, is shyness taken to an extreme.
The anxious person may avoid
speaking up, eating out, or going to
parties.
37
Obsessive-Compulsive Disorder
Persistence of unwanted thoughts (obsessions)
and urges to engage in senseless rituals
(compulsions) that cause distress.
38
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.
Brain image of an OCD
39
OCD
The obsessions may be
concerned with dirt, germs,
or toxins. The compulsions
may involve excessive hand
washing, or checking doors,
locks, or appliances. The
repetitive thoughts and
behaviors become so
persistent that they interfere
with everyday living and
cause the person distress.
Howie Mandel Story
40
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
Bettmann/ Corbis
4. Jumpy anxiety
5. Sleep problems
41
People that suffer from Post-traumatic stress
disorder (PTSD) can have insomnia that lasts for four
weeks or more following a traumatic experience.
Many combat veterans have experienced symptoms
of PTSD. Combat stress more than doubled a
veteran’s risk of alcohol abuse, depression, or anxiety.
42
Many accident and disaster survivors, and
sexual assault victims have experienced the
symptoms of PTSD.
43
Civilians too can experience PTSD from
4% from a natural disaster to
50% among those who have been kidnapped,
held captive, tortured, or raped.
The greater one’s emotional distress during a trauma
results in a higher the risk
for post-traumatic symptoms.
Debriefing survivor’s right after a trauma by getting
them to revisit the experience and
vent emotions has actually proven generally
ineffective and sometimes harmful.
44
Resilience to PTSD
Only about 10% of women and 20% of men
react to traumatic situations and develop PTSD.
Holocaust survivors show remarkable resilience
against traumatic situations.
45
All major religions of the world suggest that
surviving a trauma leads
to the growth of an individual.
For some, suffering can lead to post-traumatic
growth, including an increased appreciation of life,
more meaningful relationships, changed priorities,
and a richer spiritual life.
46
Explaining Anxiety Disorders
Freud suggested that we repress our painful
and intolerable ideas, feelings, and thoughts,
resulting in anxiety.
47
The Learning Perspective
John Coletti/ Stock, Boston
Learning theorists
suggest that fear
conditioning leads to
anxiety. This anxiety
then becomes
associated with other
objects or events
(stimulus
generalization) and is
reinforced.
48
The Learning Perspective
Investigators believe that fear responses are
inculcated through observational learning.
Young monkeys develop fear when they watch
other monkeys who are afraid of snakes.
49
The Biological Perspective
Natural Selection & Genes
50
Natural Selection
Most of our phobias focus on such objects:
spiders, snakes, and other animals, closed spaces and
heights; storms and darkness.
Think about what people
tend NOT to LEARN TO FEAR.
Why are we not afraid
of bombs dropping from the sky?
51
Genes
Pair a traumatic event with a sensitive, high strung temperament and
the result may be a new phobia.
Oh my I forgot to prepare for the
presentation!
52
The Brain
Brain scans of people with
obsessive-compulsive disorder
reveal elevated activity in
.
specific brain areas associate
d with behaviors such as
compulsive hand washing,
checking, ordering, or
hoarding.
Generalized anxiety, panic attacks,
and even OCD are linked with
brain circuits like the
anterior cingulate cortex.
Anterior Cingulate
Cortex
of an OCD patient.53
Dissociative Disorder
Conscious awareness becomes separated
(dissociated) from previous memories,
thoughts, and feelings. The person appears to
experience a sudden loss of memory or change
in identity.
Symptoms
1. Having a sense of being unreal.
2. Being separated from the body.
3. Watching yourself as if in a movie.
EEG Test
54
Dissociative Identity Disorder (DID)
Is a rare disorder in which a person exhibits two
or more distinct and alternating personalities,
formerly called Multiple Personality Disorder.
(MPD)
Lois Bernstein/ Gamma Liason
55
Chris Sizemore (DID)
People with DID exhibit two or more distinct and
alternating personalities, with the original
personality typically unaware of the other(s).
When a situation becomes overwhelmingly stressful,
people are said to dissociate themselves from it.
Their conscious awareness becomes separated from
painful memories, thoughts, and feelings.
Each personality has its own voice and mannerisms,
and the original one typically denies any awareness
of the other(s).
56
Those that accept
DID as a genuine
disorder find
support in the
distinct brain and
body states
associated with
different
personalities. One
study revealed a
shift in visual acuity
with different
personalities.
Truddi Chase
Born: June 13,
1935
Died: March
10, 2010
57
When Rabbit Howls was the first book written by a multiple and
unlike many people diagnosed with MPD; Truddi chose not to
integrate her personalities. Instead the personalities worked together
as a team and became known as The Troops. The book was later
turned into a made for television mini-series, Voices Within: The
Lives of Truddi Chase. Shelly Long portrayed Truddi Chase.
oprah interview
Truddi Chase best interviews were with Oprah Winfrey in 1983, in
Baltimore and in 1990 on The Oprah Winfrey Show.
Oprah Interview
58
Kim Noble Interview
Kim Noble is a woman who,
from the age of 14 years, spent 20
years in and out of hospital until
she made contact with Dr.
Sinason and Dr. Hale. In 1995
she began therapy and was
diagnosed with Dissociative
Identity Disorder.
Kim has 20 main personalities,
Kin Noble- Judy's Personality many fragments and 14 of the
main personalities are artists.
Having no formal art training,
these 14 artists each have their
own distinctive style, colors and
themes, ranging from solitary
Many alters are unaware that they deserts, sea scenes and abstracts
to collages and paintings with59
share a body with other artists.
traumatic content.
Psychoanalysts see these dissociative disorders as defenses
against the anxiety caused by the eruption of unacceptable
impulses.
Learning theorists see them as behaviors reinforced by
anxiety reduction. Still others view dissociative disorders
as post-traumatic disorders—a natural protective response
to traumatic childhood experiences.
Some research suggests that those diagnosed with
Dissociative identity disorder (DID) have suffered
physical, sexual, or emotional abuse as children.
Why then did children of the Holocaust, after enduring
boxcars, concentration camps, and their parents’ murders,
60
not develop 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.
61
Mood Disorders
Mood disorders are psychological disorders
characterized by emotional extremes.
Mood disorders come in two principal forms.
1. Major depressive disorder
2. Bipolar disorder
62
Major Depression
In major depressive disorder, a person—without
apparent reason—descends for weeks or months into
deep unhappiness.
Today, depression is estimated to affect 350 million
people. The World Mental Health Survey conducted
in 17 countries found that on average about 1 in 20
people reported having an episode of depression in
the previous year. (WHO, 2012)
63
Major Depressive Disorder
Depression is the “common cold” of
psychological disorders.
Blue mood
Major Depressive Disorder
Gasping for air after a
hard run
Chronic shortness of
breath
64
Major Depressive Disorder
Major depressive disorder occurs when signs of
depression last two weeks or more and are not
caused by drugs or medical conditions.
1.
2.
3.
4.
5.
Signs include:
Lethargy and fatigue
Feelings of worthlessness
Poor appetite & insomnia
Loss of interest in family & friends
Loss of interest in activities
65
Dysthymic Disorder
Dysthymic disorder lies between a blue mood
and major depressive disorder. It is a disorder
characterized by daily depression lasting two
years or more.
Blue
Mood
Dysthymic
Disorder
Major Depressive
Disorder
A less severe form of depression is dysthymic disorder—
a down-in-the-dumps mood that fills most of the day,
nearly every day, for two years or more.
66
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
67
Bipolar Disorder
Many great writers, poets, and composers
suffered from bipolar disorder. During their
manic phase creativity surged, but not during
their depressed phase.
Earl Theissen/ Hulton Getty Pictures Library
The Granger Collection
Wolfe
George C. Beresford/ Hulton Getty Pictures Library
Bettmann/ Corbis
Whitman
Clemens
Hemingway
68
69
Postpartum Depression
70
Post-partum depression
Postpartum depression occurs in women soon after
giving birth. Symptoms include sadness and
hopelessness. Counseling and antidepressants are
treatment options.
Desiree Navarro/ Getty Images
Post-partum depression
71
Postpartum depression (PPD) is the most frequent
complication of childbirth. One in 8 mothers are affected with
this illness, which means 1.3 million moms per year in the
United States alone.
PPD is not a woman’s issue – it’s a public health issue affecting
everyone – marriages, children, friends, extended family and
workmates. The great news is that with proper help, PPD is
nothing to be afraid of and is completely treatable.
Sleep deprivation, hormonal swings, and the stress and
pressure of caring for a newborn, can cause even the most
prepared and even-tempered mom to experience anxiety and
tearfulness. But how can new moms recognize the difference
between baby blues and postpartum depression?
72
1. Baby Blues Is Not PPD
There are two main ways to differentiate between the normal
Baby Blues and the disorder of PPD: severity and duration.
Fifty to 80% of mothers experience the mild symptoms of
Baby Blues such as weepiness, and feelings of dependency
and vulnerability. They are transient, typically beginning on
the second or third day after delivery, and they are gone by
the end of the second week. Baby Blues generally do not
require professional intervention. PPD can also begin soon
after delivery and usually peaks by three months postpartum
if not treated sooner, but this disorder can begin any time
during the first year. Unlike Baby Blues, the symptoms of
PPD are severe enough to disrupt the mom’s normal
functioning.
73
Three levels of Postpartum depression
1) Baby Blues
2) Postpartum Depression
3) Postpartum Psychosis
Example of postpartum psychosis
Andrea Yates Story
74
Suicide
The most severe form of behavioral response to
depression is suicide. Each year some 1 million
people commit suicide worldwide.
1.
2.
3.
4.
5.
Suicide Statistics
National differences
Racial differences
Gender differences
Age differences
Other differences
75
Suicide Facts
Suicide takes the lives of nearly 40,000 Americans every year.
Many who attempt suicide never seek professional care.
Over half of all suicides occur in adult men, ages 25-65.
Suicide rates in the United States are highest in the spring.
Over half of all suicides are completed with a firearm.
76
For young people 15-24 years old, suicide is the second leading
cause of death.
Suicide rates among the elderly are highest for those who are
divorced or widowed.
80% of people that seek treatment for depression are treated
successfully.
77
Explaining Mood Disorders
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, 1995) note that a theory
of depression should explain the following:
78
Peter Lewinsohn and his colleagues have suggested
that any theory of depression must explain:
1) The many behavioral and cognitive changes that
accompany the disorder- depressed people are inactive and
feel unmotivated. They expect their team to lose, their grades
to drop and their love to fail. When the mood lifts, these
negative thoughts and behaviors disappear.
2) Its widespread occurrence- suggests the cause must be
common
79
Theory of Depression
3. Gender differences
Women’s greater vulnerability to depression- more vulnerable to
disorders involving internalized states such as depression and anxiety.
Men’s disorders tend to be more external-alcohol abuse, antisocial
80
conduct, lack of impulse control.
4) The tendency for most major depressive episodes
to self-terminate- therapy can speed recovery but
most people eventually get better without
professional help.
5) The link between stressful events and the onset
of depression- a family member’s death, a job loss or
marital crisis can increase one’s risk of depression.
6) The disorder’s increasing rate and earlier age of
onset- the increase could reflect today’s young adults
as more likely to disclose information about
depression.
81
Biological Perspective
Genetic Influences: Mood disorders run in
families. The rate of depression is higher in
identical (50%) than fraternal twins (20%).
Jerry Irwin Photography
Linkage analysis and
association studies link
possible genes and
dispositions for depression.
82
Neurotransmitters & Depression
A reduction of
norepinephrine and
serotonin has been
found in depression.
Pre-synaptic
Neuron
Norepinephrine
Drugs that alleviate
mania reduce
norepinephrine.
Serotonin
Post-synaptic
Neuron
83
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
84
Certain neurotransmitters, including nor-epinephrine and
serotonin, seem to be scarce in depression.
Drugs that relieve depression tend to increase norephinephrine
or serotonin supplies by blocking either their reuptake (as
Prozac, Zoloft, and Paxil do with serotonin) or their chemicals
breakdown.
Repetitive physical exercise, such as jogging, reduces depression
as it increases serotonin.
Finally, the brains of depressed people have been found to be less
active. The left frontal lobe, which is active during positive
emotions, is likely to be inactive during depressed states.
85
Social-Cognitive Perspective
The social-cognitive perspective suggests that
depression arises partly from self-defeating
beliefs and negative explanatory styles.
86
Martin Seligman argues that depression is common
among young Westerners because of epidemic
hopelessness stemming from the rise of individualism
and the decline of commitment to religion and
family.
In non-Western cultures where close-knit
relationships and cooperation are the norm, major
depression is less common.
87
So the social-cognitive explanation for depression, that is selfdefeating beliefs, negative attributions and self blame surely to
support depression but do they cause depression? Before or
after being depressed, people’s thoughts are less negative.
Perhaps this is because a depressed mood triggers negative
thoughts.
88
Depression Cycle
1. Negative stressful events.
2. Pessimistic explanatory
style.
3. Hopeless depressed state.
4. These hamper the way the
individual thinks and acts,
fueling personal rejection.
89
Example
Explanatory style plays a major role in becoming depressed.
90
On the brighter side we can break the cycle of
depression at any of these points-by moving to a
different environment, by reversing our self-blame
and negative attributions, by turning our attention
outward, or by engaging in more pleasant activities
and more competent behavior.
91
Schizophrenia
If depression is the common cold of
psychological disorders, schizophrenia is the
cancer.
Nearly 1 in a 100 suffer from schizophrenia, and
throughout the world over 24 million people
suffer from this disease (WHO, 2002).
Schizophrenia strikes young people as they
mature into adults. It affects men and women
equally, but men suffer from it more severely
than women.
92
Schizophrenia
Literally schizophrenia means “split mind”.
Schizophrenia is a group of severe disorders
characterized by
a split from reality that shows itself in
1) disorganized thinking
2) disturbed perceptions
3) inappropriate emotions and actions
93
Disorganized & Delusional Thinking
This morning when I was at Hillside [Hospital], I was
making a movie. I was surrounded by movie stars …
I’m Marry Poppins. Is this room painted blue to get me
upset? My grandmother died four weeks after my
eighteenth birthday.”
(Sheehan, 1982)
Other
forms of delusions
delusions
of
This
monologue
illustratesinclude,
fragmented,
bizarre
persecution
is following
me”) or
thinking
with (“someone
distorted beliefs
called delusions
grandeur
(“I am
a king”).
(“I’m Mary
Poppins”).
94
Delusions are false beliefs, often of persecution or
grandeur, which may accompany psychotic
disorders.
Those with paranoid tendencies are particularly
prone to delusions to persecution.
Another example of disorganized thinking is a world
salad, which is jumping from one idea to another
may occur even within sentences.
95
Disorganized & Delusional Thinking
Many psychologists believe disorganized
thoughts occur because of selective attention
failure (fragmented and bizarre thoughts).
Those with schizophrenia can not block out
minute stimuli and are constantly distracted
when they should be able to give something or
someone their undivided attention.
96
Disturbed Perceptions
A schizophrenic person may perceive things
that are not there (hallucinations). Frequently
such hallucinations are auditory and lesser
visual, somatosensory, olfactory, or gustatory.
L. Berthold, Untitled. The Prinzhorn Collection, University of Heidelberg
Photos of paintings by Krannert Museum, University of Illinois at Urbana-Champaign
August Natter, Witches Head. The Prinzhorn Collection, University of Heidelberg
97
Hallucinations are sensory experiences without
sensory stimulation.
They are usually auditory and often take the form of
voices making insulting statements or giving orders.
Less commonly, people see, feel, taste, or smell things
that are not there.
When the unreal seems real, the resulting perceptions
98
are at best bizarre, at worst terrifying.
Inappropriate Emotions & Actions
A schizophrenic person may laugh at the news
of someone dying or show no emotion at all
(apathy).
Patients with schizophrenia may continually rub an
arm, rock a chair, or remain motionless
for hours (catatonia).
99
Subtypes of Schizophrenia
does not exist anymore
Schizophrenia Spectrum and
Other Psychotic Disorders
This now includes Schizophrenia, psychotic
disorders and schizotypal (personality)
disorder.
They are defined by abnormalities in one or more of the
following five domains:
delusions, hallucinations, disorganized thinking,
grossly disorganized or abnormal motor behavior, and
negative symptoms.
100
Positive and Negative Symptoms
Schizophrenics have inappropriate symptoms
(hallucinations, disorganized thinking, deluded
ways) that are not present in normal individuals
(positive symptoms).
Schizophrenics also have an absence of
appropriate symptoms (apathy, expressionless
faces, rigid bodies) that are present in normal
individuals (negative symptoms).
101
Negative Symptoms account for a substantial portion of the
morbidity associated with schizophrenia but are less prominent in
other psychotic disorders.
Two negative symptoms are particularly prominent in schizophrenia:
1) Diminished emotional expression – includes reductions in the
expression of emotions in the face, eye contact, intonation of
speech, and less movements of the hand, head, and face that
normally give emotional emphasis to speech.
2) Avolition- a decrease in motivated, self-initiated purposeful
activities ie: showing little interest in work or social activities
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Chronic and Acute Schizophrenia
When schizophrenia is slow to develop
(chronic/process) recovery is doubtful. Such
schizophrenics usually display negative
symptoms.
When schizophrenia rapidly develops
(acute/reactive) recovery is better. Such
schizophrenics usually show positive
symptoms.
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Subtypes
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Understanding Schizophrenia
Schizophrenia is a disease of the brain exhibited
by the symptoms of the mind.
Brain Abnormalities
Dopamine Overactivity: Researchers found that
schizophrenic patients express higher levels of
dopamine D4 receptors in the brain.
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Abnormal Brain Activity
Brain scans show abnormal activity in the
frontal cortex, thalamus, and amygdala of
schizophrenic patients. Adolescent
schizophrenic patients also have brain lesions.
Paul Thompson and Arthur W. Toga, UCLA Laboratory of Neuro
Imaging and Judith L. Rapport, National Institute of Mental Health
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Modern brain-scanning techniques indicate that
people with chronic schizophrenia have abnormal
activity in multiple brain areas.
Some appear to have abnormally low brain activity
in the frontal lobes (which are critical for reasoning,
planning, and problem solving), or enlarged, fluidfilled areas and a corresponding shrinkage of
cerebral tissue (the greater the shrinkage the more
severe the thought disorder).
Another smaller-than-normal area in persons with
schizophrenia is the thalamus. This may help to
explain why people with schizophrenia have
difficulty filtering sensory input and focusing
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attention.
Abnormal Brain Morphology
Schizophrenia patients may exhibit
morphological changes in the brain like
enlargement of fluid-filled ventricles.
Both Photos: Courtesy of Daniel R. Weinberger, M.D., NIH-NIMH/ NSC
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Viral Infection
Schizophrenia has also been observed in
individuals who contracted a viral infection
(flu) during the middle of their fetal
development.
For example, people are at
increased risk of schizophrenia,
if during the middle of their fetal development,
their country experienced a flu epidemic.
People born in densely populated areas, where
viral diseases spread more readily, also seem at
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greater risk for schizophrenia.
Genetic Factors
The likelihood of an individual suffering from
schizophrenia is 50% if their identical twin has
the disease (Gottesman, 1991).
0 10 20 30 40 50
Identical
Both parents
Fraternal
One parent
Sibling
Nephew or niece
Unrelated
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Genetic Factors
The following shows the prevalence of
schizophrenia in identical twins as seen in
different countries.
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The nearly 1-in-100 odds of any person developing
schizophrenia become about 1 in 10 if a family
member has it, and close to 1 in 2 if an identical twin
has the disorder.
Adoption studies confirm the genetic contribution
to schizophrenia.
An adopted child’s probability of developing the
disorder is greater if the biological parents have
schizophrenia, but not if the adopted parents have it.
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Psychological Factors
Psychological and environmental factors can
trigger schizophrenia if the individual is
genetically predisposed (Nicols & Gottesman,
1983).
Courtesy of Genain Family
Genain Sisters
The genetically identical
Genain
sisters suffer from
schizophrenia. Two more than
others, thus there are
contributing environmental
factors.
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Warning Signs
Early warning signs of schizophrenia include:
1. A mother’s long lasting schizophrenia.
2. Birth complications, oxygen deprivation and
low-birth weight.
3. Short attention span and poor muscle
coordination.
4. Disruptive and withdrawn behavior.
5. Emotional unpredictability.
6. Poor peer relations and solo play.
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Personality Disorders
Personality disorders
are characterized by
inflexible and
enduring behavior
patterns that impair
social functioning.
They are usually
without anxiety,
depression, or
delusions.
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Personality Disorders
1) One cluster expresses anxiety (e.g., avoidant)
2) A second cluster expresses eccentric behaviors (e.g.,
schizoid)
3) A third exhibits dramatic or impulsive behaviors
(e.g., histrionic).
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Paranoid- a pattern of distrust & suspiciousness
Schizoid- pattern of detachment from social relationships and
restricted range of emotional expression
Schizotypal- pattern of acute discomfort in close relationships,
cognitive and perceptual distortions & eccentricities of
behavior
Antisocial- pattern of disregard for, violation of, rights of
others
Borderline- pattern of instability of relationships, self-image,
and affects, and marked impulsivity
Histrionic- pattern of attention seeking and excessive
emotions
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Narcissistic- pattern to exaggerate their own importance, need
for admiration and lack of empathy
Avoidant- pattern of social inhibition, feelings of inadequacy,
and hypersensitivity to negative evaluation fearful sensitivity
to rejection that predisposes the withdrawn
Dependent- pattern of submissive and clinging behavior
related to the excessive need to be taken care of
Obsessive-compulsive- a pattern of preoccupation with
orderliness, perfectionism, and control.
Personality change due to another medical condition – ie:
from frontal lobe lesion
Other specified personality disorder and unspecified
personality disorder
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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.
Robert Hare- PCL-R
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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.
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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
compared to normals (Raine et al., 1999; 2000).
Courtesy of Adrian Raine,
University of Southern California
Normal
Murderer
121
Understanding Antisocial
Personality Disorder
The likelihood that one will commit a crime doubles
when childhood poverty is compounded with
obstetrical complications (Raine et al., 1999; 2000).
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Most criminals do not fit the description of antisocial
personality disorder. Why?
Most criminals actually show responsible concern for
their friends and family members.
Brain scans of murderers with this disorder have
revealed reduced activity in the front lobes, an area
of the cortex that helps control impulses.
This helps explain why people with antisocial personality
disorder exhibit marked deficits in frontal lobe cognitive
functions, such as planning, organization, and inhibition.
A genetic predisposition may interact with environmental
influences to produce this disorder.
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Rates of Psychological Disorders
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Rates of Psychological Disorders
The prevalence of psychological disorders during
the previous year is shown below (WHO, 2004).
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Risk and Protective Factors
Risk and protective factors for mental disorders
(WHO, 2004).
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Risk and Protective Factors
127
Mental illness is defined as “collectively all
diagnosable mental disorders” or “health conditions
that are characterized by alterations in thinking,
mood, or behavior (or some combination thereof)
associated with distress and/or impaired functioning.”
Depression is the most common type of mental illness,
affecting more than 26% of the U.S. adult population.
It has been estimated that by the year 2020, depression
will be the second leading cause of disability
throughout the world, trailing only ischemic heart
disease.
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Evidence has shown that mental disorders, especially
depressive disorders, are strongly related to the
occurrence, successful treatment, and course of many
chronic diseases including diabetes, cancer,
cardiovascular disease, asthma, and obesity and
many risk behaviors for chronic disease; such as,
physical inactivity, smoking, excessive drinking, and
insufficient sleep.
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Mental Health Indicators
In the health care and public health arena, more
emphasis and resources have been devoted to
screening, diagnosis, and treatment of mental illness
than mental health. Little has been done to protect the
mental health of those free of mental illness.
Researchers suggest that there are indicators of mental
health, representing three domains.
These include the following:
Emotional well-being
such as perceived life satisfaction, happiness,
cheerfulness, peacefulness.
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Psychological well-being
such as self-acceptance, personal growth including
openness to new experiences, optimism,
hopefulness, purpose in life, control of one’s
environment, spirituality, self-direction, and
positive relationships.
Social well-being
social acceptance, beliefs in the potential of people
and society as a whole, personal self-worth and
usefulness to society, sense of community.
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