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PSYCHOPATHOLOGY DIAGNOSIS AND TREATMENT STRATEGIES ANXIETY, SOMATOFORM, AND DISSOCIATIVE DISORDERS Disorder Subtypes Major Symptoms Anxiety disorders Phobias Intense, irrational fear of objectively nondangerous situations or things, leading to disruptions of behavior. Generalized anxiety disorder Excessive anxiety not focused on a specific situation or object; freefloating anxiety. Panic disorder Repeated attacks of intense fear involving physical symptoms such as faintness, dizziness, and nausea. Obsessive-compulsive disorder Persistent ideas or worries accompanied by ritualistic behaviors performed to neutralize the anxiety-driven thoughts. Conversion disorder A loss of physical ability (e.g., sight, hearing) that is related to psychological factors. Hypochondriasis Preoccupation with or belief that one has serious illness in the absence of any physical evidence. Somatization disorder Wide variety of somatic complaints that occur over several years and are not the result of a known physical disorder. Pain disorder Preoccupation with pain in the absence of physical reasons for the pain. Amnesia/fugue Sudden, unexpected loss of memory, which may result in relocation and the assumption of a new identity. Dissociative identity disorder (multiple personality disorder) Appearance within same person of two or more distinct identities, each with a unique way of thinking and behaving. 2 Somatoform disorders Dissociative disorders InRev15a ANXIETY DISORDERS PANIC DISORDER GENERALIZED ANXIETY DISORDER PHOBIAS OBSESSIVE-COMPULSIVE DISORDER POST-TRAUMATIC STRESS DISORDER 3 PANIC DISORDER Experience reoccurring episodes of anxiety attacks; unpredictable; some situations might become related to it. Anxiety attack: 5 needed may last a couple of minutes to hours heart palpitations tense muscles, especially chest muscles often misinterpreted for heart attack, choking sensation from tight neck muscles, faint or dizzy feeling, increase sweat, hot or cold flashes. 4 GENERALIZED ANXIETY DISORDER Persistent level of anxiety lasting at least one month Symptoms: Motor: Tension of muscles: shakes, tremble, unable to relax, twitch, startle easily Autonomic hyperactivity: Sweat, increased heart rate, cold hands, hot, cold flashes, light headed and dizzy Apprehension--worry constantly Vigilance and scanning: hyperattentive to things in the environment, distractible, hard to concentrate, impatient, irritable. 5 PHOBIA Irrational fear response of specific stimuli SOCIAL PHOBIAS AGORAPHOBIA SPECIFIC PHOBIAS 6 OBSESSIVE-COMPULSIVE DISORDER Marked by overt ritualistic behavior and persistent intruding thoughts Occurs at a frequency so high as to interfere with daily functioning 7 SOMATOFORM DISORDERS HYPOCHONDRIASIS CONVERSION HYSTERIA 8 HYPOCHONDRIASIS Preoccupation with body and illness No relief if given healthy diagnosis Just as tense--travel and search for new physicians 9 CONVERSION DISORDER Individual has dramatic physical symptoms with no organic cause. 1. Paralysis of legs/arms/ total 2. Anesthesia--lost sense of touch with parts of body 3. Analgesia--feel no pain 4. Other common experiences: nausea, lower back pain, dizziness, hysterical blindness, deafness, unexplained headaches 5. Unusually INDIFFERENT to symptoms 6 .Secondary gain for having symptoms 7. May disappear while asleep or under hypnosis 8. Craft Paralysis: symptoms selective to job--paralyzed hands of violinist or tennis player. 9. Symptoms make no common sense neurologically 10 DISSOCIATIVE DISORDERS DISSOCIATIVE AMNESIA DISSOCIATIVE FUGUE DISSOCIATIVE IDENTITY DISORDER 11 DISSOCIATIVE AMNESIA Memory for certain events from 1 hour to 3 months is lost Person is not distressed by loss of memory-intellectual and skills still there. Theorized as a loss of memory (repression) for traumatic event 12 DISSOCIATIVE FUGUE Amnesia for entire life & self Starts a new life in a new location -called travelling amnesiac Cause: extreme stress & need to flee Can last for days, weeks, years. Extremely rare except on Soaps! 13 DISSOCIATIVE IDENTITY DISORDER Dominance of 2 or more distinct personalities Generally amnesic for existence of others Controversial Diagnosis 14 56 Fig131 Precursors Diathesis Genetic factors Stress Outcome Poor selfunderstanding Brain disease Disorder (e.g. schizophrenia) Vulnerability Early learning experiences Stressful family dynamics Bad family dynamics Social stresses Diathesis Stress Model of Disorders AFFECTIVE DISORDERS MAJOR DEPRESSION DYSTHYMIC DISORDER BIPOLAR DISORDER CYCLOTHYMIC DISORDER SEASONAL AFFECTIVE DISORDER 16 CLINICAL DEPRESSION Emotions major disturbing problem but also problem in cognition (selfdefeating thoughts) 1. Dysphoric mood for a minimum of 2 weeks plus 4 of following: Change in appetite usually decrease Change in sleep--insomnia or hypersomnia Change in amount of psychomotor activity-slow or agitated Fatigue or loss of energy Feelings of worthlessness, self critical or inappropriate guilt Poor concentration Suicide or suicidal ideation 17 BIPOLAR DISORDER MANIC-DEPRESSION Elevated mood-elation and mania alternating with depressive thoughts Mania: inflated self esteem: too self confident talkative w/flight of ideas increased activity, interests, social decreased need of sleep, distracted concern that will harm selves not judge consequences of actions shopping spree--self destructive buying pattern 18 57 INCIDENCE OF DEPRESSION Major depression Bipolar disorder Fig147 80 70 60 50 Risk 40 30 20 10 Prevalence in general population Fraternal twins Identical twins Prevalence in general population Fraternal twins Identical twins 19 Creativity and Madness Artists Pa u l Ga u gu in ( SA) , Vince n t v a n G og h (H , S) , Ern st Lu d wig Ki rchner ( H, S) , Ed wa r d Lea r, Miche la nge lo, Ed va r d Meu n ch (H ) , Ge o r gia O 'Kee ff e (H ) , Ge o r ge R om ney , Da nte Ga b r ie l Ro ss et t i( SA) Writers Poets Ha n s Chr is t ia n An d er sen Willia m Fa u lk ner (H) F. Scot t Fit zger ald (H ) , Erne stH em in gwa y (H, S) , Her ma nn Hess e (H , SA) , Hen r ik Ibs en Henr y Ja me s Willia m Jam es Sa m u el Cle m en s ( Ma r kT wa in ) Jos ep h Co n ra d ( SA) Ch a r les Di cken s Isak Dine sen (SA ) Ral ph Wald o Eme r so n Her m a n M elvill e Eu gene O'Ne ill (H , SA) Ma r y Sh elley Rob ert Lo u is Ste ven so n Leo Tols t o y Tenne ss ee Wil liam s ( H) Ma ry Wo llsto necr a ft ( SA) Vir gi n ia Woolf ( H, S) Willia m Blak e Rob ert Burn s Lo r d Byr o n Sa m u el Tay lo r Col er id ge Emil yD ickin so n T.S. Eli o t (H) Oli ve r Golds m it h Ger a r d Ma n ley Hop kin s Victo r Hu go Sa m u el Jo hn so n Jo hn Kea ts Jam es Ru ss ell Lo well Rob ert Lo well (H ) Ed n a S t . Vincen t Mill ay ( H) Bo ri s Pa st ern ak ( H) Sylv ia Plat h (H , S) Ed ga r A lla n P o e ( SA) Ezr a P o u nd ( H) An ne Sex to n (H , S) Pe r cy Byss he She lley ( SA) Alf re d , Lor d Te n ny so n, Dy la n Th om a s Wa lt W h it ma n 20 SCHIZOPHRENIA PARANOID CATATONIA DISORGANIZED HEBEPHRENIA SIMPLE RESIDUAL 21 22 15_05 Fig15_5 C Max Schizophrenic behavior A Threshold Challenging events Normal behavior D B Min Low Vulnerability High 23 PERSONALITY DISORDERS ANTISOCIAL AVOIDANT BORDERLINE DEPENDENT HISTRIONIC NARCISSISTIC OBSESSIVE- PARANOID COMPULSIVE SCHIZOTYPAL 24 Fig15_5 Type Typical Features Paranoid Suspiciousness and distrust of others, all of whom are assumed to be hostile. Schizoid Detachment from social relationship; restricted range of emotion. Schizotypal Detachment from, and great discomfort in, social relationships; odd perceptions, thoughts, beliefs, and behaviors. Depedent Helplessness; excessive need to betaken care of; submissive and clinging behavior; difficulty in making decisions. Obsessivecompulsive Preoccupation with orderliness, perfection, and control. Avoidant Inhibition in social situations; feelings of inadequacy; oversensitivity to criticism. Histrionic Excessive emotionality and preoccupation with being the center of attention; emotional shallowness; overly dramatic behavior. Narcissistic Exaggerated ideas of self-importance and achievements; preoccupation with fantasies of success; arrogance. Borderline Lack of stability in interpersonal relationships, self-image, and emotion; impulsivity; angry outbursts; intense fear of abandonment; recurring suicidal gestures. Antisocial Shameless disregard for, and violation of, other people's rights. Tab15_5 25 26 DEVELOPMENTAL DISORDERS Autism Academic Skills Disorder Attention Deficit Disorder w/hyperactivity Senile Dementia 27 TREATMENT PSYCHOANALYSIS BEHAVIOR HUMANISTIC COGNITIVE BIOMEDICAL SIGMUND FREUD PSYCHOANALYSIS Resistance Catharsis Transference Interpretation Insight 29 DEINSTITUTIONALIZATION 30 APPROACHES TO PSYCHOLOGICAL TREATMENT Dim ens ion Classical Psychoanalytic Contem porary Psychodynam ic Phenom enological Behavioral Nature of the human being Driven by sexua l and aggressive urges InRev16a Therapist’s role Neutral; help s client explore mea ning of free association s and other material from the unconscio us Active; develops Facilitates clien t’s growth; relationsh ip with clien t as some therapists are a model for other active, some nondirective relationsh ips Teacher/trainer wh o helps client replace undesira ble though ts and behavio rs; active, actionoriented Time frame Emphasizes un resolved unconscio us conflicts from the distant past Understand ing the past, but focusing on curre nt relationsh ips Current beha vior and thoughts; may not need to know origin al causes in order to create chang e Goals Psychosexual ma turity through insi ght; strengthenin g of ego functions Correction of effects of Expanded a wareness, failures of early fulfillment of potentia l; attachment; develop ment self-acceptance of satisfying intimate relationsh ips Changes in thinking an d behavin g in particular classes of situations; better self-manage ment Typical methods Free association ; dream analysis, ana lysis of transference Analysis of transference and countertransferen ce Systematic desensitiza tion, modelin g, assertiveness an d social skills training, positive reinforcement , aversive condition ing, punish ment, extinction, cognitive restructuring Driven by the nee d for human rela tionships Has free will, choi ce, and capacity for selfactualizatio n Here and no w; focus on immediate exp erience Reflection-o riented interviews de signed to convey uncon ditional positive rega rd, empathy, congruence; exercises to promote self-awa reness A product of social learning and condi tioning; behaves on the b asis of past experien ce CARL ROGERS CLIENT CENTERED 32 HUMANISTIC THERAPY 55 BASIC HUMAN NEEDS Need for self-actualization OTHERS' RESPONSES RESULT Unconditional positive regard Self-actualization SELF GUIDES Self = ideals Need for positive regard Conditional positive regard MENTAL HEALTH EFFECTS Sadness Disappointment Depression Selfdiscrepancies Self = oughts Anxiety Shame Guilt 33 ROLLO MAY EXISTENTIAL THERAPY 34 ALBERT BANDURA MODELING 35 BEHAVIOR AND COGNITIVE SYSTEMATIC DESENSITIZATION FLOODING IMPLOSIVE AVERSION MODELING RATIONAL EMOTIVE ELLIS STRESS INNOCULATION COGNITIVE --BECK 36 BIOLOGICAL TREATMENTS FOR PSYCHOLOGICAL DISORDERS M ethod Typical Disorde rs Treated Possible Side Effects M echanism of Action InRev16b Electroconvulsive therapy (ECT) Severe depression Temporary confusion, memory loss Uncertain Psychosurgery Schizophrenia, severe depression, obsessivecompulsive disorder Listlessness, overemotionality, epilepsy Uncertain Psychoactive drugs Anxiety disorders, depression, obsessivecompulsive disorder, mania, schizophrenia Variable, depending on drug used: movement disorders, physical dependence Alteration of neurotransmitter systems in the brain 37 ELECTRO-CONVULSIVE SHOCK TREATMENT (ECT) Single most effective treatment for psychotic depression Used as treatment of last resort Actual understanding of how it works is not complete--disrupts electrical impulses of brain Within two to four weeks many see profound mood elevation Side Effects include memory loss (usually short term) 38 PSYCHOSURGERY PREFRONTAL LOBOTOMY Removal of brain tissue to relieve symptoms Pre-frontal lobotomy first used on gorillas and found to calm aggression; applied to patients in mental institutions beginning in the 1950’s Often used on schizophrenics bringing flat affect Today smaller amount of tissue can be removed from specific areas showing malfunction--cingulotomy Can be very effective at removing tumor and other tissue causing abnormal behaviors 39 BIOMEDICAL TREATMENTS Drug Treatment Options: Anti-Anxiety Xanax GABA neurotransmitter Anti-Depressant Serotonin drugs Prozac and Norepinephrine Anti-Psychotic drugs Thorazine Dopamine 40 Average untreated person Average treated person Number of people 80% of untreated persons No improvement Outstanding improvement PSYCHOTHERAPY VS NONE 41