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Mental Disorders © Kip Smith, 2003 Topics Categories of mental disorders Neuroses Psychoses Neuroses Psychoses Diagnosis using the DSM © Kip Smith, 2003 Mental distress ≠ mental disorder Just because you are bummed out doesn’t mean you are mentally ill For example, sadness, pessimism and low self-esteem are all parts of normal mental life, as long as they Do not persist Do not have a biological origin Are essentially voluntary © Kip Smith, 2003 E.g., you know WHY you are temporarily bummed Mental disorders Neurosis Distressed but still rational and social Psychosis Loss of contact with reality, irrational ideas & distorted perception © Kip Smith, 2003 Criteria for considering behavior to be a Disorder The behavior must be Unjustifiable & Maladaptive & Atypical & Disturbing == Distressing © Kip Smith, 2003 Distressing behavior may be rational or not If behavior is NOT in the person’s best interest, then the behavior suggests some form of psychosis Rationality Acting in a manner that you know is in your own best interest = will help you achieve your goal Neurotics are rational but distressed Psychotics are NOT rational © Kip Smith, 2003 Examples of Neuroses Anorexia - bulimia Anxiety Mood disorders Depression Mania Bipolar syndrome Personality disorders Obsessive - compulsive Post trauma stress Phobia Anti-social Histrionia Narcissism Sexual dysfunction Substance abuse © Kip Smith, 2003 Sometimes it is hard to tell when a behavior crosses the line from neurosis to psychosis Anorexia - bulimia Anorexia nervosa is a life-threatening eating disorder defined by a refusal to maintain body weight within 15 % of an individual's minimal normal weight. Other essential features of this disorder include an intense fear of gaining weight, a distorted body image, and amenorrhea (absence of at least three consecutive menstrual cycles when otherwise expected to occur) in women. Sometimes people starve and binge-purge, depending on the extent of weight loss. This can be physically very dangerous. People who present an on-going preoccupation with food and weight even at lesser weight reductions would benefit from exploring their cognitive and relationship skills. http://www.nami.org/helpline/anorexia.htm © Kip Smith, 2003 If you know someone with anorexia Force her to confront it http://www.anred.com © Kip Smith, 2003 http://www.altrue.net/ site/anadweb/ Anxiety (Neurosis) Continually tense, apprehensive; persistent autonomic (sympathetic) arousal Obsessive-compulsive Phobia © Kip Smith, 2003 Anxiety with unwanted repetitive thoughts and/or actions High need for perfection and order Persistent irrational fear Panic Post-traumatic stress Obsession Recurrent and persistent thoughts, impulses, or images that are experienced, at some time during the disturbance, as intrusive and inappropriate and that cause marked anxiety or distress The thoughts, impulses, or images are not simply excessive worries about real-life problems The person attempts to ignore or suppress the thoughts, impulses, or images, or to neutralize them with some other thought or action The person recognizes that the obsessional thoughts, impulses, or images are a product of his or her own mind (not imposed from without as in thought insertion) © Kip Smith, 2003 Compulsion Repetitive behaviors (e.g., hand washing, ordering, checking) or mental acts (e.g., praying, counting, repeating words silently) that the person feels driven to perform in response to an obsession, or according to rules that must be applied rigidly The behaviors or mental acts are aimed at preventing or reducing distress or preventing some dreaded event or situation; however, these behaviors or mental acts either are not connected in a realistic way with what they are designed to neutralize or prevent or are clearly excessive http://www.narsad.org/bd/ocp.html © Kip Smith, 2003 Obsessive-Compulsive disorder At some point during the course of the disorder, the person has recognized that the obsessions or compulsions are excessive or unreasonable. Note: This does not apply to children. The obsessions or compulsions cause marked distress, are time consuming (take more than one hour a day), or significantly interfere with the person's normal routine, occupational (or academic) functioning, or usual social activities or relationships. Reprinted from the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. Copyright 1994 American Psychiatric Association. © Kip Smith, 2003 Mood Disorders (Neurosis) Depression, Feelings of: worthlessness low self-esteem pessimism low motivation generalization of negative attitudes psychomotor dysfunction More women than men (report) being depressed 2: 1 © Kip Smith, 2003 Mania Euphoria Inflated self-esteem Grandiosity Fragmented attention Bipolar Mood swings between the hopelessness of depression and the euphoria of mania (manic depression) Depression http://www.narsad.org/bd/dep.html Depression isn't just a brief blue mood or a passing sadness that lifts in a few hours or even a few days. People who have depression -- or, in more formal clinical terms, major depressive disorder -experience at least five of the following symptoms, which must include the first or second, nearly every day, all day, for at least two weeks: © Kip Smith, 2003 Symptoms of depression, 1 Persistent depressed mood, including feelings of sadness or emptiness Loss of interest or pleasure in activities or hobbies that were once enjoyed, including sex Feelings of hopelessness and pessimism Feelings of guilt, worthlessness, and helplessness Insomnia, early-morning awakening, or oversleeping Loss of appetite accompanied by weight loss or overeating accompanied by weight gain © Kip Smith, 2003 Symptoms of depression, 2 Decreased energy, fatigue, and feeling "slowed down" Restlessness and irritability Difficulty concentrating, remembering, and making decisions Thoughts of suicide or death (not just fear of dying) or suicide attempts Persistent physical symptoms, such as headaches, digestive disorders, or chronic pain, that do not respond to medical treatment and for which no physical cause can be found © Kip Smith, 2003 Mania A manic episode is characterized by a distinct period of a mood change that is either elevated (to the point of elation), expansive, or irritable. During this phase, which may last from several days through several months, the patient's behavior causes difficulties in both professional and social activities. http://www.narsad.org/bd/bip.html © Kip Smith, 2003 Symptoms of mania Decreased need for sleep Increased pressure of speech Distractibility Irritability Inflated self-esteem or grandiosity Excessive involvement in activities that have a high risk for pain consequences that are not recognized © Kip Smith, 2003 Bipolar syndrome Behavior oscillates between depression and mania Used to be called manic depression © Kip Smith, 2003 Bipolar manic episodes Frequently, those experiencing a manic episode do not realize they are affected and will therefore resist any medical treatment attempt. Close friends will recognize the mood and behavior patterns as being excessive, while the casual observer may not see anything disturbing. The patient may become frankly psychotic with delusions and hallucinations. © Kip Smith, 2003 Bipolar depressed episodes A depressive phase usually lasts two weeks to many months, during which the time the patient will experience a lack of interest or pleasure in all activities. Patients may describe themselves as feeling sad or blue, devoid of motivation, or worthless. These feelings and thoughts may or may not be stated openly in front of others. © Kip Smith, 2003 Bipolar depressed episodes The course of a depressive episode may vary from person to person. Symptoms may develop over a period of days or weeks, or they may occur suddenly, without warning. Sudden onset of this condition can be caused by external factors, including stress, death of a family member, or divorce. Duration of an episode will vary and depends on medical treatment employed. http://www.narsad.org/bd/bip.htm © Kip Smith, 2003 Personality Disorders (Neurosis) Inflexible and enduring patterns of behavior that impair social functioning Relatively untreatable Patients do not think anything is wrong & resist treatment Histrionic Narcissistic Exaggerated self-image (aided by fantasies) Anti-Social © Kip Smith, 2003 Display shallow, attention-getting emotions, sexual aggression Complete disregard for others’ rights Lack of a conscience for wrong-doing Psychosis Alzheimer’s Schizophrenia Dissociation Amnesia Fugue Identity disorder © Kip Smith, 2003 Poster Boy for Psychosis Ted Kaczynski, exprofessor of math, lived alone in a shack, rarely bathed, sent bombs to strangers © Kip Smith, 2003 Schizophrenia Schizophrenia is classified in people who exhibit the following traits: Characteristic symptoms Social/occupational dysfunction Duration > 6 months No mood disorders (depression, mania, mixed) Not due to drug use Not due to developmental disorder (autism) © Kip Smith, 2003 Symptoms of schizophrenia Two (or more) of the following, each present for a significant portion of time during a 1-month period (or less if successfully treated): 1. delusions 2. hallucinations 3. disorganized speech (e.g., frequent derailment or incoherence) 4 grossly disorganized or catatonic behavior 5. negative symptoms, i.e., affective flattening, alogia, or avolition © Kip Smith, 2003 Positive and negative symptoms Positive symptoms Disorganized, delusional thinking Distorted perception, Inappropriate emotions and actions Bizarre behavior ± Paranoia Pervasive distrust and suspicion of others ± Catatonia © Kip Smith, 2003 Negative symptoms No interest in other people or social relationships Detached from social relationships Emotionally cold with flat affect Pervasive interpersonal deficits Poverty of speech Apathetic attention Social dysfunction For a significant portion of time since the onset of the disturbance, one or more major areas of functioning such as work, interpersonal relations, or self-care are markedly below the level achieved prior to the onset (or when the onset is in childhood or adolescence, failure to achieve expected level of interpersonal, academic, or occupational achievement). http://www.narsad.org/bd/sch.html © Kip Smith, 2003 Psychopharmacology of Schizophrenia Too much dopamine in the frontal lobe The mind runs amok © Kip Smith, 2003 Dissociative Disorders (Psychoses) A disruption in the usually integrated functions of consciousness, memory, identity or perception Amnesia Fugue Fail to recall past & Run away & Assume new identity Identity Disorder © Kip Smith, 2003 Fail to recall events Multiple personalities Most rare, usually faked Diagnosing neuroses and psychoses © Kip Smith, 2003 Diagnostic and Statistical Manual of Mental Disorders DSM 4th edition Provides a multidimensional approach to diagnosing disorders diagnostic criteria prevalence data case illustrations Uses decision trees to guide diagnoses © Kip Smith, 2003 DSM’s 5 Dimensions of Disorder 1 2 3 4 5 Clinical symptoms Personality disorders General medical conditions Psychosocial & environmental problems Global assessment of functioning The dimensions are NOT mutually exclusive © Kip Smith, 2003 1 Clinical symptoms Anxiety Depression Schizophrenia Substance abuse Includes alcohol © Kip Smith, 2003 Disorders Sleep Sexual Eating 2 Personality Disorders Obsessive-compulsive Dependent personality Passively allows others to make decisions Antisocial personality © Kip Smith, 2003 3 General Medical Conditions Any medical conditions relevant to understanding or treatment Organic brain damage Diabetes HIV © Kip Smith, 2003 4 Psychosocial, Environmental Problems Social support structure Death of a loved one Discrimination Economic or legal problems © Kip Smith, 2003 5 Global Assessment of Functioning Current occupational functioning Highest level of functioning in the past year © Kip Smith, 2003 Sample DSM Decision Tree for a Patient with Depressed Mood If YES If NO Due to a medical condition Mood disorder due to a med. cond. Due to drug, meds, or toxins Substance-induced mood disorder Periods of mania and at least one period of depression Bipolar disorder, Type 1 Periods of mild mania and mild depression Bipolar disorder, Type 2 Periods of depression with psychosis (delusions or hallucinations) when not depressed Schizophrenia © Kip Smith, 2003 Depression Models of Psychological Disorders Medical model Diathesis-Stress Model Disorders are diseases Disorders can be diagnosed on the basis of their symptoms Disorders can be treated and, often, cured © Kip Smith, 2003 Biological predisposition + Stress -> disorder “Humpty dumpty had a thin shell. Didn’t break until he fell.”