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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 102 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. 103 Subtypes 104 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. 105 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 106 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 107 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 108 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 109 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 110 Genetic Factors The following shows the prevalence of schizophrenia in identical twins as seen in different countries. 111 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. 112 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. 113 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. 114 Personality Disorders Personality disorders are characterized by inflexible and enduring behavior patterns that impair social functioning. They are usually without anxiety, depression, or delusions. 115 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). 116 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 117 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 118 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 119 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. 120 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). 122 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. 123 Rates of Psychological Disorders 124 Rates of Psychological Disorders The prevalence of psychological disorders during the previous year is shown below (WHO, 2004). 125 Risk and Protective Factors Risk and protective factors for mental disorders (WHO, 2004). 126 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. 128 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. 129 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. 130 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. 131