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Psychological Disorders Chapter 16 1 Monday, March 26, 2012 Psychological Disorders Perspectives on Psychological Disorders Defining Psychological Disorders Understanding Psychological Disorders Classifying Psychological Disorders Labeling Psychological Disorders 2 Monday, March 26, 2012 Psychological Disorders Anxiety Disorders Generalized Anxiety Disorder and Panic Disorder Phobias Obsessive-Compulsive Disorders Post-Traumatic Stress Disorders Anxiety Disorder Explanation 3 Monday, March 26, 2012 Psychological Disorders Mood Disorders Major Depressive Disorders Bipolar Disorder Mood Disorder Explanation Schizophrenia Symptoms of Schizophrenia Subtypes of Schizophrenia 4 Monday, March 26, 2012 Psychological Disorders Schizophrenia Understanding Schizophrenia Personality Disorders Rates of Psychological Disorders 5 Monday, March 26, 2012 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) 6 Monday, March 26, 2012 Psychological Disorders People are fascinated by the exceptional, the unusual, and the abnormal. This fascination may be caused by two reasons: 7 Monday, March 26, 2012 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. 7 Monday, March 26, 2012 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. 8 Monday, March 26, 2012 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). 9 Monday, March 26, 2012 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. 10 Monday, March 26, 2012 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)11 Monday, March 26, 2012 Medical Perspective Philippe Pinel (1745-1826) from France, insisted that madness was not due to demonic possession, but an ailment of the mind. Monday, March 26, 2012 George Wesley Bellows, Dancer in a Madhouse, 1907. © 1997 The Art Institute of Chicago Dance in the madhouse. 12 Medical Model When physicians discovered that syphilis led to mental disorders, they started using medical models to review the physical causes of these disorders. 1. Etiology: Cause and development of the disorder. 2. Diagnosis: Identifying (symptoms) and distinguishing one disease from another. 3. Treatment: Treating a disorder in a psychiatric hospital. 4. Prognosis: Forecast about the 13 disorder. Monday, March 26, 2012 Biopsychosocial Perspective Assumes that biological, socio-cultural, and psychological factors combine and interact to produce psychological disorders. 14 Monday, March 26, 2012 Classifying Psychological Disorders The American Psychiatric Association rendered a Diagnostic and Statistical Manual of Mental Disorders (DSM) to describe psychological disorders. 15 Monday, March 26, 2012 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, DSM-IV-TR (Text Revision, 2000), describes 400 psychological disorders compared to 60 in the 1950s. 15 Monday, March 26, 2012 Multiaxial Classification Axis I Is a Clinical Syndrome (cognitive, anxiety, mood disorders [16 syndromes]) present? Axis II Is a Personality Disorder or Mental Retardation present? Axis III Is a General Medical Condition (diabetes, hypertension or arthritis etc) also present? Axis IV Axis V Are Psychosocial or Environmental Problems (school or housing issues) also present? What is the Global Assessment of the person’s functioning? 16 Monday, March 26, 2012 Multiaxial Classification Note 16 syndromes in Axis I 17 Monday, March 26, 2012 Multiaxial Classification Note Global Assessment for Axis V 18 Monday, March 26, 2012 Goals of DSM 1. 2. Describe (400) disorders. Determine how prevalent the disorder is. 19 Monday, March 26, 2012 Goals of DSM 1. 2. Describe (400) disorders. Determine how prevalent the disorder is. Disorders outlined by DSM-IV are reliable. Therefore, diagnoses by different professionals are similar. 19 Monday, March 26, 2012 Goals of DSM 1. 2. Describe (400) disorders. Determine how prevalent the disorder is. Disorders outlined by DSM-IV are reliable. Therefore, diagnoses by different professionals are similar. Others criticize DSM-IV for “putting any kind of behavior within the compass of psychiatry.” 19 Monday, March 26, 2012 Labeling Psychological Disorders 1. Critics of the DSM-IV argue that labels may stigmatize individuals. Monday, March 26, 2012 Elizabeth Eckert, Middletown, NY. From L. Gamwell and N. Tomes, Madness in America, 1995. Cornell University Press. Asylum baseball team (labeling) 20 Labeling Psychological Disorders 2. Labels may be helpful for healthcare professionals when communicating with one another and establishing therapy. 21 Monday, March 26, 2012 Labeling Psychological Disorders Theodore Kaczynski 22 (Unabomber) Monday, March 26, 2012 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. Anxiety Disorders Feelings of excessive apprehension and anxiety. 1. 2. 3. 4. Generalized anxiety disorders Phobias Panic disorders Obsessive-compulsive disorders 23 Monday, March 26, 2012 Generalized Anxiety Disorder 24 Monday, March 26, 2012 Generalized Anxiety Disorder Symptoms 1. Persistent and uncontrollable tenseness and apprehension. 24 Monday, March 26, 2012 Generalized Anxiety Disorder Symptoms 1. Persistent and uncontrollable tenseness and apprehension. 2. Autonomic arousal. 24 Monday, March 26, 2012 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. 24 Monday, March 26, 2012 Panic Disorder 25 Monday, March 26, 2012 Panic Disorder Symptoms Minute-long episodes of intense dread which may include feelings of terror, chest pains, choking, or other frightening sensations. 25 Monday, March 26, 2012 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. 25 Monday, March 26, 2012 Phobia Marked by a persistent and irrational fear of an object or situation that disrupts behavior. 26 Monday, March 26, 2012 Kinds of Phobias 27 Monday, March 26, 2012 Kinds of Phobias Agoraphobia Phobia of open places. 27 Monday, March 26, 2012 Kinds of Phobias Agoraphobia Acrophobia Phobia of open places. Phobia of heights. 27 Monday, March 26, 2012 Kinds of Phobias Agoraphobia Acrophobia Claustrophobia Phobia of open places. Phobia of heights. Phobia of closed spaces. 27 Monday, March 26, 2012 Kinds of Phobias Agoraphobia Acrophobia Phobia of open places. Phobia of heights. Claustrophobia Phobia of closed spaces. Hemophobia Phobia of blood. 27 Monday, March 26, 2012 Obsessive-Compulsive Disorder Persistence of unwanted thoughts (obsessions) and urges to engage in senseless rituals (compulsions) that cause distress. 28 Monday, March 26, 2012 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 29 Monday, March 26, 2012 Post-Traumatic Stress Disorder Four or more weeks of the following symptoms constitute post-traumatic stress disorder (PTSD): Bettmann/ Corbis 30 Monday, March 26, 2012 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 30 Monday, March 26, 2012 Resilience to PTSD Only about 10% of women and 20% of men react to traumatic situations and develop PTSD. 31 Monday, March 26, 2012 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. 31 Monday, March 26, 2012 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. All major religions of the world suggest that surviving a trauma leads to the growth of an individual. 31 Monday, March 26, 2012 Explaining Anxiety Disorders 32 Monday, March 26, 2012 Explaining Anxiety Disorders Freud suggested that we repress our painful and intolerable ideas, feelings, and thoughts, resulting in anxiety. 32 Monday, March 26, 2012 The Learning Perspective John Coletti/ Stock, Boston 33 Monday, March 26, 2012 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. 33 Monday, March 26, 2012 The Learning Perspective 34 Monday, March 26, 2012 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. 34 Monday, March 26, 2012 The Biological Perspective Natural Selection has led our ancestors to learn to fear snakes, spiders, and other animals. Therefore, fear preserves the species. 35 Monday, March 26, 2012 The Biological Perspective Natural Selection has led our ancestors to learn to fear snakes, spiders, and other animals. Therefore, fear preserves the species. Twin studies suggest that our genes may be partly responsible for developing fears and anxiety. Twins are more likely to share phobias. 35 Monday, March 26, 2012 The Biological Perspective 36 Monday, March 26, 2012 S. Ursu, V.A. Stenger, M.K. Shear, M.R. Jones, & C.S. Carter (2003). Overactive action monitoring in obsessive-compulsive disorder. Psychological Science, 14, 347-353. Anterior Cingulate Cortex of an OCD patient. The Biological Perspective Anterior Cingulate Cortex of an OCD patient. 36 Monday, March 26, 2012 S. Ursu, V.A. Stenger, M.K. Shear, M.R. Jones, & C.S. Carter (2003). Overactive action monitoring in obsessive-compulsive disorder. Psychological Science, 14, 347-353. Generalized anxiety, panic attacks, and even OCD are linked with brain circuits like the anterior cingulate cortex. Dissociative Disorder Conscious awareness becomes separated (dissociated) from previous memories, thoughts, and feelings. 37 Monday, March 26, 2012 Dissociative Disorder Conscious awareness becomes separated (dissociated) from previous memories, thoughts, and feelings. Symptoms 1. Having a sense of being unreal. 37 Monday, March 26, 2012 Dissociative Disorder 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. 37 Monday, March 26, 2012 Dissociative Disorder 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. 37 Monday, March 26, 2012 Dissociative Identity Disorder (DID) Is a disorder in which a person exhibits two or more distinct and alternating personalities, formerly called multiple personality disorder. Monday, March 26, 2012 Lois Bernstein/ Gamma Liason Chris Sizemore (DID) 38 DID Critics Critics argue that the diagnosis of DID increased in the late 20th century. DID has not been found in other countries. 39 Monday, March 26, 2012 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. 39 Monday, March 26, 2012 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. Monday, March 26, 2012 39 16-2 Mood Disorders 40 Monday, March 26, 2012 Mood Disorders Emotional extremes of mood disorders come in two principal forms. 1. 2. Major depressive disorder Bipolar disorder 40 Monday, March 26, 2012 Major Depressive Disorder Depression is the “common cold” of psychological disorders. In a year, 5.8% of men and 9.5% of women report depression worldwide (WHO, 2002). Blue mood Major Depressive Disorder 41 Monday, March 26, 2012 Major Depressive Disorder Depression is the “common cold” of psychological disorders. In a year, 5.8% of men and 9.5% of women report depression worldwide (WHO, 2002). Blue mood Gasping for air after a hard run Major Depressive Disorder Chronic shortness of breath 41 Monday, March 26, 2012 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. Monday, March 26, 2012 Signs include: Lethargy and fatigue Feelings of worthlessness Loss of interest in family & friends Loss of interest in activities 42 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 43 Monday, March 26, 2012 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 43 Monday, March 26, 2012 Bipolar Disorder Formerly called manic-depressive disorder. An alternation between depression and mania signals bipolar disorder. 44 Monday, March 26, 2012 Bipolar Disorder Formerly called manic-depressive disorder. An alternation between depression and mania signals bipolar disorder. Depressive Symptoms 44 Monday, March 26, 2012 Bipolar Disorder Formerly called manic-depressive disorder. An alternation between depression and mania signals bipolar disorder. Depressive Symptoms Gloomy Withdrawn Inability to make decisions Tired Slowness of thought Monday, March 26, 2012 44 Bipolar Disorder Formerly called manic-depressive disorder. An alternation between depression and mania signals bipolar disorder. Depressive Manic Symptoms Symptoms Gloomy Withdrawn Inability to make decisions Tired Slowness of thought Monday, March 26, 2012 44 Bipolar Disorder Formerly called manic-depressive disorder. An alternation between depression and mania signals bipolar disorder. Depressive Manic Symptoms Symptoms Gloomy Withdrawn Inability to make decisions Tired Slowness of thought Monday, March 26, 2012 Elation Euphoria Desire for action Hyperactive Multiple ideas 44 Bipolar Disorder Many great writers, poets, and composers suffered from bipolar disorder. During their manic phase creativity surged, but not during their depressed phase. Hemingway 45 Monday, March 26, 2012 Earl Theissen/ Hulton Getty Pictures Library Clemens The Granger Collection Wolfe George C. Beresford/ Hulton Getty Pictures Library Bettmann/ Corbis Whitman Explaining Mood Disorders 1. 2. Behavioral and cognitive changes Common causes of depression 46 Monday, March 26, 2012 Explaining Mood Disorders Since depression is so prevalent worldwide, investigators want to develop a theory of depression that will suggest ways to treat it. 1. 2. Behavioral and cognitive changes Common causes of depression 46 Monday, March 26, 2012 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: 1. 2. Behavioral and cognitive changes Common causes of depression 46 Monday, March 26, 2012 Theory of Depression 3. Gender differences 47 Monday, March 26, 2012 Theory of Depression 4. 5. Depressive episodes self-terminate. Depression is increasing, especially in the teens. Desiree Navarro/ Getty Images Post-partum depression Monday, March 26, 2012 48 Suicide The most severe form of behavioral response to depression is suicide. Each year some 1 million people commit suicide worldwide. Suicide Statistics 1. National differences 2. Racial differences 3. Gender differences 4. Age differences 5. Other differences Monday, March 26, 2012 49 51 Monday, March 26, 2012 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. 50 Monday, March 26, 2012 Neurotransmitters & Depression A reduction of norepinephrine and serotonin has been found in depression. Drugs that alleviate mania reduce norepinephrine. Pre-synaptic Neuron Norepinephrine Serotonin Post-synaptic Neuron 51 Monday, March 26, 2012 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 52 Monday, March 26, 2012 Social-Cognitive Perspective The social-cognitive perspective suggests that depression arises partly from selfdefeating beliefs and negative explanatory styles. 53 Monday, March 26, 2012 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. 54 Monday, March 26, 2012 Example Explanatory style plays a major role in becoming depressed. Monday, March 26, 2012 55 16-3 Schizophrenia, Somatoform Disorders 58 Monday, March 26, 2012 Schizophrenia If depression is the common cold of psychological disorders, schizophrenia is the cancer. 56 Monday, March 26, 2012 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). 56 Monday, March 26, 2012 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. 56 Monday, March 26, 2012 Symptoms of Schizophrenia The literal translation is “split mind.” A group of severe disorders characterized by the following: 1. 2. 3. Disorganized and delusional thinking. Disturbed perceptions. Inappropriate emotions and actions. 57 Monday, March 26, 2012 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.” This monologue illustrates fragmented, bizarre thinking with distorted beliefs called delusions (“I’m Mary Poppins”). Other forms of delusions include, delusions of persecution (“someone is following me”) or grandeur (“I am a king”). 58 Monday, March 26, 2012 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.” Other forms of delusions include, delusions of persecution (“someone is following me”) or grandeur (“I am a king”). 58 Monday, March 26, 2012 Disorganized & Delusional Thinking Many psychologists believe disorganized thoughts occur because of selective attention failure (fragmented and bizarre thoughts). 59 Monday, March 26, 2012 Disturbed Perceptions August Natter, Witches Head. The Prinzhorn Collection, University of Heidelberg Photos of paintings by Krannert Museum, University of Illinois at Urbana-Champaign Monday, March 26, 2012 60 L. Berthold, Untitled. The Prinzhorn Collection, University of Heidelberg A schizophrenic person may perceive things that are not there (hallucinations). Frequently such hallucinations are auditory and lesser visual, somatosensory, olfactory, or gustatory. 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). 61 Monday, March 26, 2012 Subtypes of Schizophrenia Schizophrenia is a cluster of disorders. These subtypes share some features, but there are other symptoms that differentiate these subtypes. 62 Monday, March 26, 2012 Positive and Negative Symptoms Schizophrenics have inappropriate symptoms (hallucinations, disorganized thinking, deluded ways) that are not present in normal individuals (positive symptoms). 63 Monday, March 26, 2012 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). 63 Monday, March 26, 2012 Chronic and Acute Schizophrenia When schizophrenia is slow to develop (chronic/process) recovery is doubtful. Such schizophrenics usually display negative symptoms. 64 Monday, March 26, 2012 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. 64 Monday, March 26, 2012 Subtypes 65 Monday, March 26, 2012 Understanding Schizophrenia Schizophrenia is a disease of the brain exhibited by the symptoms of the mind. Brain Abnormalities 66 Monday, March 26, 2012 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. 66 Monday, March 26, 2012 Abnormal Brain Activity Paul Thompson and Arthur W. Toga, UCLA Laboratory of Neuro Imaging and Judith L. Rapport, National Institute of Mental Health Brain scans show abnormal activity in the frontal cortex, thalamus, and amygdala of schizophrenic patients. Adolescent schizophrenic patients also have brain lesions. Monday, March 26, 2012 67 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 68 Monday, March 26, 2012 Viral Infection Schizophrenia has also been observed in individuals who contracted a viral infection (flu) during the middle of their fetal development. 69 Monday, March 26, 2012 Genetic Factors The likelihood of an individual suffering from schizophrenia is 50% if their identical twin has the disease (Gottesman, 1991). 0 Identical 10 20 30 40 50 Both parents Fraternal One parent Sibling Nephew or niece Unrelated Monday, March 26, 2012 70 Genetic Factors The following shows the prevalence of schizophrenia in identical twins as seen in different countries. 71 Monday, March 26, 2012 Psychological Factors Psychological and environmental factors can trigger schizophrenia if the individual is genetically predisposed (Nicols & Gottesman, 1983). Courtesy of Genain Family Genain Sisters Monday, March 26, 2012 The genetically identical Genain sisters suffer from schizophrenia. Two more than others, thus there are contributing environmental factors. 72 Warning Signs Early warning signs of schizophrenia include: 73 Monday, March 26, 2012 Warning Signs Early warning signs of schizophrenia include: 1. A mother’s long lasting schizophrenia. 73 Monday, March 26, 2012 Warning Signs Early warning signs of schizophrenia include: 1. A mother’s long lasting schizophrenia. 2. Birth complications, oxygen deprivation and low-birth weight. 73 Monday, March 26, 2012 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. 73 Monday, March 26, 2012 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. 73 Monday, March 26, 2012 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. 73 Monday, March 26, 2012 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. 6. Monday, March 26, 2012 Emotional unpredictability. Poor peer relations and solo play. 73 16-4 Personality Disorders 77 Monday, March 26, 2012 Personality Disorders Personality disorders are characterized by inflexible and enduring behavior patterns that impair social functioning. They are usually without anxiety, depression, or delusions. 74 Monday, March 26, 2012 Cluster A (odd or eccentric disorders) • Paranoid personality disorder: characterized by irrational suspicions and mistrust of others. • Schizoid personality disorder: lack of interest in social relationships, seeing no point in sharing time with others. • Schizotypal personality disorder: characterized by odd behavior or thinking. 79 Monday, March 26, 2012 Cluster B (dramatic, emotional or erratic disorders) • Antisocial personality disorder: a pervasive disregard for the law and the rights of others. • Borderline personality disorder: extreme "black and white" thinking, instability in relationships, self-image, identity and behavior often leading to self-harm and impulsivity. Borderline personality disorder occurs in 3 times as many females as males. • Histrionic personality disorder: pervasive attentionseeking behavior including inappropriate sexual seductiveness and shallow or exaggerated emotions. • Narcissistic personality disorder: a pervasive pattern of grandiosity, need for admiration, and a lack of empathy. 80 Monday, March 26, 2012 Cluster C (anxious or fearful disorders) • Avoidant personality disorder: social inhibition, feelings of inadequacy, extreme sensitivity to negative evaluation and avoidance of social interaction. • Dependent personality disorder: pervasive psychological dependence on other people. • Obsessive-compulsive personality disorder (not the same as obsessive-compulsive disorder): characterized by rigid conformity to 81 rules, moral codes and excessive orderliness. Monday, March 26, 2012 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. 75 Monday, March 26, 2012 Sociopath vs. Psychopath • Sociopath- Erratic, tend to leave several clues and evidence. Unable to maintain normal relationships – Jeffrey Dahmer, Ted Kaczynski, Klebold/Harris, Timothy McVeigh • Psychopath- Controlled, tend to have well planned crimes, try not to leave any clues behind. Appear normal in their social relationships – Ted Bundy, Charles Manson, Richard Ramirez, David Berkowitz, BTK 83 Monday, March 26, 2012 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. 76 Monday, March 26, 2012 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). Monday, March 26, 2012 Murderer Courtesy of Adrian Raine, University of Southern California Normal 77 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). 78 Monday, March 26, 2012 Rates of Psychological Disorders 79 Monday, March 26, 2012 Rates of Psychological Disorders The prevalence of psychological disorders during the previous year is shown below (WHO, 2004). 80 Monday, March 26, 2012 Risk and Protective Factors Risk and protective factors for mental disorders (WHO, 2004). 81 Monday, March 26, 2012 Risk and Protective Factors 82 Monday, March 26, 2012 Low Socioeconomic Class •Why? 91 Monday, March 26, 2012 Therapy Chapter 17-1 83 Monday, March 26, 2012 Therapy The Psychological Therapies Psychoanalysis Humanistic Therapies Behavior Therapies Cognitive Therapies Group and Family Therapies 84 Monday, March 26, 2012 Therapy Evaluating Psychotherapies The Effectiveness of Psychotherapy The Relative Effectiveness of Different Therapies Alternative Therapies Evaluated Commonalities Among Psychotherapies Culture and Values in Psychotherapies Monday, March 26, 2012 85 Therapy The Biomedical Therapies Drug Therapies Brain Stimulation Psychosurgery Preventing Psychological Disorders 86 Monday, March 26, 2012 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. The Granger Collection The Granger Collection Monday, March 26, 2012 87 History of Insane Treatment Philippe Pinel in France, Dorthea Dix and Nellie Bly in America founded humane movements to care for the mentally sick. Culver Pictures http://wwwihm.nlm.nih.gov Philippe Pinel (1745-1826) Dorthea Dix (1745-1826) Nellie Bly 88 Monday, March 26, 2012 Therapies Psychotherapy involves an emotionally charged, confiding interaction between a trained therapist and a mental patient. 89 Monday, March 26, 2012 Therapies Psychotherapy involves an emotionally charged, confiding interaction between a trained therapist and a mental patient. Biomedical therapy uses drugs or other procedures that act on the patient’s nervous system, curing him or her of psychological disorders. 89 Monday, March 26, 2012 Therapies Psychotherapy involves an emotionally charged, confiding interaction between a trained therapist and a mental patient. Biomedical therapy uses drugs or other procedures that act on the patient’s nervous system, curing him or her of psychological disorders. An eclectic approach uses various forms of healing techniques depending upon the client’s unique problems. 89 Monday, March 26, 2012 Psychological Therapies We will look at four major forms of psychotherapies based on different theories of human nature: 1. 2. 3. 4. Psychoanalytical theory Humanistic theory Behavioral theory Cognitive theory 90 Monday, March 26, 2012 Psychoanalysis The first formal psychotherapy to emerge was psychoanalysis, developed by Sigmund Freud. Edmund Engleman Sigmund Freud's famous couch 91 Monday, March 26, 2012 Psychoanalysis: Aims Since psychological problems originate from childhood repressed impulses and conflicts, the aim of psychoanalysis is to bring repressed feelings into conscious awareness where the patient can deal with them. When energy devoted to id-ego-superego conflicts is released, the patient’s anxiety lessens. 92 Monday, March 26, 2012 Psychoanalysis: Methods Dissatisfied with hypnosis, Freud developed the method of free association to unravel the unconscious mind and its conflicts. 93 Monday, March 26, 2012 Psychoanalysis: Methods Dissatisfied with hypnosis, Freud developed the method of free association to unravel the unconscious mind and its conflicts. The patient lies on a couch and speaks about whatever comes to his or her mind. http://www.english.upenn.edu Monday, March 26, 2012 93 Psychoanalysis: Methods 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. 94 Monday, March 26, 2012 Psychoanalysis: Methods 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. 94 Monday, March 26, 2012 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. 95 Monday, March 26, 2012 Psychodynamic Therapies Influenced by Freud, in a face-to-face setting, psychodynamic therapists understand symptoms and themes across important relationships in a patient’s life. 96 Monday, March 26, 2012 Psychodynamic Therapies Interpersonal psychotherapy, a variation of psychodynamic therapy, is effective in treating depression. It focuses on symptom relief here and now, not an overall personality change. 97 Monday, March 26, 2012 Humanistic Therapies Humanistic therapists aim to boost selffulfillment by helping people grow in selfawareness and self-acceptance. 98 Monday, March 26, 2012 Person-Centered Therapy Developed by Carl Rogers, person-centered therapy is a form of humanistic therapy. 99 Monday, March 26, 2012 Person-Centered Therapy Developed by Carl Rogers, person-centered therapy is a form of humanistic therapy. The therapist listens to the needs of the patient in an accepting and nonjudgmental way, addressing problems in a productive way and building his or her selfesteem. 99 Monday, March 26, 2012 Humanistic Therapy The therapist engages in active listening and echoes, restates, and clarifies the patient’s thinking, acknowledging expressed feelings. Michael Rougier/ Life Magazine © Time Warner, Inc. Monday, March 26, 2012 100 Behavior Therapy Therapy that applies learning principles to the elimination of unwanted behaviors. 101 Monday, March 26, 2012 Behavior Therapy Therapy that applies learning principles to the elimination of unwanted behaviors. To treat phobias or sexual disorders, behavior therapists do not delve deeply below the surface looking for inner causes. 101 Monday, March 26, 2012 Classical Conditioning Techniques Counterconditioning is a procedure that conditions new responses to stimuli that trigger unwanted behaviors. It is based on classical conditioning and includes exposure therapy and aversive conditioning. 102 Monday, March 26, 2012 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. 103 Monday, March 26, 2012 Exposure Therapy Exposure therapy involves exposing people to fear-driving objects in real or virtual environments. Both Photos: Bob Mahoney/ The Image Works N. Rown/ The Image Works 104 Monday, March 26, 2012 Systematic Desensitization A type of exposure therapy that associates a pleasant, relaxed state with gradually increasing anxiety-triggering stimuli commonly used to treat phobias. 105 Monday, March 26, 2012 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. 106 Monday, March 26, 2012 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. 107 Monday, March 26, 2012 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. 107 Monday, March 26, 2012 Token Economy In institutional settings therapists may create a token economy in which patients exchange a token of some sort, earned for exhibiting the desired behavior, for various privileges or treats. 108 Monday, March 26, 2012 Cognitive Therapy Teaches people adaptive ways of thinking and acting based on the assumption that thoughts intervene between events and our emotional reactions. 109 Monday, March 26, 2012 Cognitive 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. 110 Monday, March 26, 2012 Cognitive 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. 110 Monday, March 26, 2012 Cognitive Therapy for Depression Rabin et al., (1986) trained depressed patients to record positive events each day, and relate how they contributed to these events. Compared to other depressed patients, trained patients showed lower depression scores. Monday, March 26, 2012 111 Stress Inoculation Training Meichenbaum (1977, 1985) trained people to restructure their thinking in stressful situations. 112 Monday, March 26, 2012 Stress Inoculation Training Meichenbaum (1977, 1985) trained people to restructure their thinking in stressful situations. “Relax, the exam may be hard, but it will be hard for everyone else too. I studied harder than most people. Besides, I don’t need a perfect score to get a good grade.” 112 Monday, March 26, 2012 Cognitive-Behavior Therapy Cognitive therapists often combine the reversal of self-defeated thinking with efforts to modify behavior. 113 Monday, March 26, 2012 Cognitive-Behavior Therapy Cognitive therapists often combine the reversal of self-defeated thinking with efforts to modify behavior. Cognitive-behavior therapy aims to alter the way people act (behavior therapy) and alter the way they think (cognitive therapy). 113 Monday, March 26, 2012 Group Therapy Group therapy normally consists of 6-9 people attending a 90-minute session that can help more people and costs less. Clients benefit from knowing others have similar problems. © Mary Kate Denny/ PhotoEdit, Inc. Monday, March 26, 2012 114 Family Therapy Family therapy treats the family as a system. Therapy guides family members toward positive relationships and improved communication. 115 Monday, March 26, 2012 Monday, March 26, 2012 Would you believe me if I said seeing you laugh and smile makes me happier than I’ve ever been before? Monday, March 26, 2012 Would you believe me if I said seeing you laugh and smile makes me happier than I’ve ever been before? Or if anytime I’m not with you I miss you? Monday, March 26, 2012 Would you believe me if I said seeing you laugh and smile makes me happier than I’ve ever been before? Or if anytime I’m not with you I miss you? While reading this you might already know this is from ‘you know who.’ Monday, March 26, 2012 Would you believe me if I said seeing you laugh and smile makes me happier than I’ve ever been before? Or if anytime I’m not with you I miss you? While reading this you might already know this is from ‘you know who.’ Kathryn will you go to prom with me? -Love, Drew Monday, March 26, 2012 17-2 Evaluating Therapy 126 Monday, March 26, 2012 Evaluating Therapies Who do people turn to for help with psychological difficulties? 116 Monday, March 26, 2012 Evaluating Psychotherapies Within psychotherapies cognitive therapies are most widely used, followed by psychoanalytic and family/group therapies. 117 Monday, March 26, 2012 Is Psychotherapy Effective? It is difficult to gauge the effectiveness of psychotherapy because there are different levels upon which its effectiveness can be measured. 118 Monday, March 26, 2012 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? 118 Monday, March 26, 2012 Client’s Perceptions If you ask clients about their experiences of getting into therapy, they often overestimate its effectiveness. Critics however remain skeptical. 119 Monday, March 26, 2012 Client’s Perceptions If you ask clients about their experiences of getting into therapy, they often overestimate its effectiveness. Critics however remain skeptical. 1. 2. 3. Clients enter therapy in crisis, but crisis may subside over the natural course of time (regression to normalcy). Clients may need to believe the therapy was worth the effort. Clients generally speak kindly of their therapists. 119 Monday, March 26, 2012 Clinician’s Perceptions Like clients, clinicians believe in therapy’s success. They believe the client is better off after therapy than if the client had not taken part in therapy. 120 Monday, March 26, 2012 Clinician’s Perceptions Like clients, clinicians believe in therapy’s success. They believe the client is better off after therapy than if the client had not taken part in therapy. 1. 2. 3. Clinicians are aware of failures, but they believe failures are the problem of other therapists. If a client seeks another clinician, the former therapist is more likely to argue that the client has developed another psychological problem. Clinicians are likely to testify to the efficacy of their therapy regardless of the outcome of treatment. 120 Monday, March 26, 2012 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. 121 Monday, March 26, 2012 Outcome Research Research shows that treated patients were 80% better than untreated ones. 122 Monday, March 26, 2012 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 123 Monday, March 26, 2012 Evaluating Alternative Therapies Lilienfeld (1998) suggests comparing scientific therapies against popular therapies through electronic means. The results of such a search are below: 124 Monday, March 26, 2012 Eye Movement Desensitization and Reprocessing (EMDR) In EMDR therapy, the therapist attempts to unlock and reprocess previous frozen traumatic memories by waving a finger in front of the eyes of the client. EMDR has not held up under scientific testing. 125 Monday, March 26, 2012 Light Exposure Therapy Courtesy of Christine Brune Seasonal Affective Disorder (SAD), a form of depression, has been effectively treated by light exposure therapy. This form of therapy has been scientifically validated. 126 Monday, March 26, 2012 Commonalities Among Psychotherapies Three commonalities shared by all forms of psychotherapies are the following: © Mary Kate Denny/ PhotoEdit, Inc. 1. A hope for demoralized people. 2. A new perspective. 3. An empathic, trusting and caring relationship. 127 Monday, March 26, 2012 Culture and Values in Psychotherapy Psychotherapists may differ from each other and from clients in their personal beliefs, values, and cultural backgrounds. 128 Monday, March 26, 2012 Culture and Values in Psychotherapy Psychotherapists may differ from each other and from clients in their personal beliefs, values, and cultural backgrounds. A therapist search should include visiting two or more therapists to judge which one makes the client feel more comfortable. 128 Monday, March 26, 2012 Therapists & Their Training Clinical psychologists: They have PhDs mostly. They are experts in research, assessment, and therapy, all of which is verified through a supervised internship. Clinical or Psychiatric Social Worker: They have a Masters of Social Work. Postgraduate supervision prepares some social workers to offer psychotherapy, mostly to people with everyday personal and family problems. 129 Monday, March 26, 2012 Therapists & Their Training Counselors: Pastoral counselors or abuse counselors work with problems arising from family relations, spouse and child abusers and their victims, and substance abusers. Psychiatrists: They are physicians who specialize in the treatment of psychological disorders. Not all psychiatrists have extensive training in psychotherapy, but as MDs they can prescribe medications. 130 Monday, March 26, 2012 The Biomedical Therapies These include physical, medicinal, and other forms of biological therapies. 1. Drug Treatments 2. Surgery 3. Electric-shock therapy 131 Monday, March 26, 2012 Drug Therapies Psychopharmacology is the study of drug effects on mind and behavior. With the advent of drugs, hospitalization in mental 132 institutions has rapidly declined. Monday, March 26, 2012 Drug Therapies However, many patients are left homeless on the streets due to their ill-preparedness to cope independently outside in society. Les Snider/ The Image Works 133 Monday, March 26, 2012 Double-Blind Procedures To test the effectiveness of a drug, patients are tested with the drug and a placebo. Two groups of patients and medical health professionals are unaware of who is taking the drug and who is taking the placebo. 134 Monday, March 26, 2012 Schizophrenia Symptoms Inappropriate symptoms present (positive symptoms) Appropriate symptoms absent (negative symptoms) Hallucinations, disorganized thinking, deluded ways. Apathy, expressionless faces, rigid bodies. 135 Monday, March 26, 2012 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. 136 Monday, March 26, 2012 Atypical Antipsychotic Clozapine (Clozaril) blocks receptors for dopamine and serotonin to remove the negative symptoms of schizophrenia. 137 Monday, March 26, 2012 Antianxiety Drugs Antianxiety drugs (Xanax and Ativan) depress the central nervous system and reduce anxiety and tension by elevating the levels of the Gammaaminobutyric acid (GABA) neurotransmitter. 138 Monday, March 26, 2012 Antidepressant Drugs 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. 139 Monday, March 26, 2012 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. 140 Monday, March 26, 2012 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. Monday, March 26, 2012 141 Alternatives to ECT Transcranial Magnetic Stimulation (TMS) In TMS, a pulsating magnetic coil is placed over prefrontal regions of the brain to treat depression with minimal side effects. 142 Monday, March 26, 2012 Psychosurgery http://www.epub.org.br Psychosurgery was popular even in Neolithic times. Although used sparingly today, about 200 such operations do take place in the US alone. 143 Monday, March 26, 2012 Psychosurgery Psychosurgery is used as a last resort in alleviating psychological disturbances. Psychosurgery is irreversible. Removal of brain tissue changes the mind. 144 Monday, March 26, 2012 Psychosurgery http://www.epub.org.br Modern methods use stereotactic neurosurgery and radiosurgery (Laksell, 1951) that refine older methods of psychosurgery. http://www.epub.org.br 145 Monday, March 26, 2012 Preventing Psychological Disorders “It is better to prevent than cure.” Peruvian Folk Wisdom Preventing psychological disorders means removing the factors that affect society. Those factors may be poverty, meaningless work, constant criticism, unemployment, racism, and sexism. 146 Monday, March 26, 2012 Psychological Disorders are Biopsychosocial in Nature 147 Monday, March 26, 2012