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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 What behaviors do we consider to be abnormal? Evaluate examples. What basis did you use to determine if the behavior was abnormal? 9 Psychological Disorders To study the abnormal is the best way of understanding the normal. William James (1842-1910) There are 450 million people suffering from psychological disorders (WHO, 2004). See transparency for incidence of specific psychological disorders. Depression and schizophrenia exist in all cultures of the world. Significance? 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). The diasthesis-stress model incorporates these points. See transparency chart.. 11 Deviant, Distressful & Dysfunctional Carol Beckwith Deviant behavior (going naked) in one culture may be considered normal, while in others it may lead to arrest. Deviant behavior must be accompanied by distress. 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 DEFINING PSYCHOLOGICAL DISORDERS • Standards for deviant behavior vary by culture and context. Examples? • Standards for deviant behavior also vary with time. Examples? • Deviance alone is not enough to label behavior as abnormal. Why? 13 DEFINING ABNORMAL BEHAVIOR • Deviant and distressful behavior must generally also be judged dysfunctional to be considered abnormal. • Use of term psychopathology 14 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. See transparency for other treatments. John W. Verano Trephination (boring holes in the skull to remove evil forces) 15 Medical Perspective Philippe Pinel (1745-1826) from France, insisted that madness was not due to demonic possession, but an ailment of the mind (a moral model). Term: bedlam George Wesley Bellows, Dancer in a Madhouse, 1907. © 1997 The Art Institute of Chicago Dance in the madhouse. 16 Medical Model When physicians discovered that syphilis led to mental disorders, they started using medical models to review the physical causes of these disorders. Implies behavior is an illness. 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. 17 Biopsychosocial Perspective Assumes that biological, socio-cultural, and psychological factors combine and interact to produce psychological disorders. 18 BIOPSYCHOSOCIAL MODEL OF PSYCHOPATHOLOGIES • Assumptions that disorders are influenced by: – – – – Genetic predispositions Physiological states Inner psychological dynamics 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, DSM-IV-TR (Text Revision, 2000), describes 400 psychological disorders compared to 60 in the 1950s. DSM-IV will be issued soon (2013?) 20 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? 21 Multiaxial Classification Note 16 syndromes in Axis I 22 Multiaxial Classification Note Global Assessment for Axis V 23 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.” 24 DSM-IV ACTIVITY • • • • Read three case studies. Skim over handouts for DSM (Axes I, IV, and V) Analyze the three case studies using the handouts. Set up three sheets of paper according to the model Classification Outline Sheet. Fill in for each case study. Hand in for homework credit. 25 Labeling Psychological Disorders 1. Critics of the DSM-IV argue that labels may stigmatize individuals. Describe the Rosenhan study. 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. 3. What stereotypes are caused or supported by the media? 4. Labels can be self-fulfilling prophesies. Explain. 27 Labeling Psychological Disorders 3. Elaine Thompson/ AP Photo “Insanity” labels raise moral and ethical questions about how society should treat people who have disorders and have committed crimes. (We will cover when we do antisocial personality disorder.) Theodore Kaczynski (Unabomber) 28 Anxiety Disorders Characterized by distressing, persistent anxiety or maladaptive behaviors that reduce anxiety.. 1. 2. 3. 4. 5. Generalized anxiety disorders Phobias Panic disorders Obsessive-compulsive disorders Post traumatic stress disorder 29 Generalized Anxiety Disorder (free floating anxiety) Symptoms 1. Persistent and uncontrollable tenseness and apprehension. 2. Autonomic arousal. 3. Inability to identify or avoid the cause of certain feelings. 4. Often accompanied by depression 30 Panic Disorder Symptoms Minutes-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. 31 Phobia Marked by a persistent and irrational fear of an object or situation that disrupts behavior. 32 Kinds of Phobias Agoraphobia Acrophobia Claustrophobia Hemophobia Phobia of open places. Phobia of heights. Phobia of closed spaces. Phobia of blood. 33 SOCIAL PHOBIA Intense fear of being scrutinized by others. Severe shyness. 34 Your morning routine: • Describe your typical morning routine from the time you get up in the morning until you leave for school. • Raise your hand if: your routine the same every day it would cause you tension if someone changed or intruded on it 35 OBSESSIVE-COMPULSIVE DISORDER • Listen to the description of one compulsive person. Decide what the difference is between her behavior and your morning routine: 36 Obsessive-Compulsive Disorder Persistence of unwanted thoughts (obsessions) and urges to engage in senseless rituals (compulsions) that cause distress. 37 OBSESSIVE-COMPULSIVE DISORDER • How do obsessions and compulsions become linked? – The compulsions originate to reduce the anxiety brought on by the obsession. – Ritualized behavior carries out the compulsion – The person then becomes anxious about the ritual. • Example: United Streaming 38 EXAMPLES • Obsession: A young woman is continuously terrified by the thought that cars might careen onto the sidewalk and run over her. Compulsion: She always walks as far from the street pavement as possible and wears red clothes so that she will be immediately visible to an out-of-control car. 39 EXAMPLES • Obsession: A college student has the urge to shout obscenities while sitting through lectures in classes. • Compulsion: Carefully monitoring his watch, he bites his tongue every sixty seconds in order to ward off the inclination to shout. 40 EXAMPLES • Obsession: A young boy worries incessantly that something terrible might happen to his mother while sleeping at night. • Compulsion: On his way up to bed each night, he climbs the stairs according to a fixed sequence of three steps up, followed by two steps down in order to ward off danger. 41 EXAMPLES • Obsession: A mother is tormented by the concern that she might inadvertently contaminate food as she cooks dinner for her family. • Compulsion: Every day she sterilizes all cooking utensils in boiling water, scours every pot and pan before placing food in it, and wears rubber gloves while handling food. 42 OBSESSIVE COMPULSIVE VIDEO CLIP • http://player.discoveryeducation.com/index. cfm?guidAssetId=1871337F-EF55-4D19A74B1C8863FCB873&blnFromSearch=1&produ ctcode=US 43 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 44 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 5. Sleep problems 6. Dose response relationship Bettmann/ Corbis 4. Jumpy anxiety 45 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. 46 Explaining Anxiety Disorders Freud suggested that we repress our painful and intolerable ideas, feelings, and thoughts, resulting in anxiety. PSYCHODYNAMIC 47 The Learning Perspective BEHAVIORAL 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. Review behavioral studies, esp neg reinforcement. 48 The Learning Perspective BEHAVIORAL 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 has led our ancestors to learn to fear snakes, spiders, and other animals. Therefore, fear preserves the species. Predisposition (vulnerability, diasthesis) Grooming, territorialism, washing up lead to ? Twin studies suggest that our genes may be partly responsible for developing fears and anxiety. Twins are more likely to share phobias. 50 The Biological Perspective 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 (esp for OCD). Fear circuits also in amygdala. Antidepressants can help. Anterior Cingulate Cortex of an OCD patient. 51 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. 4. Fugue: amnesia with flight 52 DISSOCIATIVE IDENTITY DISORDER CAUSES • Abuse, often sexual • Dissociation or separation from trauma: conscious awareness become separated from painful memories, thoughts, and feelings • Presumes existence of repressed memories (controversial) • Psychoanalytic and learning theory: a way of dealing with extreme anxiety • A cultural phenomenon – a disorder created by therapists in a particular social context? 53 Dissociative Identity Disorder (DID) Is a disorder in which a person exhibits two or more distinct and alternating personalities, formerly called multiple personality disorder. This is NOT schizophrenia. Lois Bernstein/ Gamma Liason Chris Sizemore (DID) 54 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. 55 Mood Disorders (Affective Disorders) Emotional extremes of mood disorders come in two principle forms. 1. Major depressive disorder – prolonged lethargy and hopelessness 2. Bipolar disorder – alternate between depression and mania formerly called manic depressive disorder. 56 ACTIVITY: WRITING CASE STUDIES • Use the provided Mood Disorders Worksheet and DSM-IV sheets: Axes I, IV and V • Develop case studies for a person with Major Depressive Disorder and another person with Bipolar Disorder. Write a description which you attach to the worksheet. • Analyze case studies for diagnosis • Back of sheet: Continue writing case study for depressed individual focusing on causes from two different perspectives 57 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 Gasping for air after a hard run Chronic shortness of breath 58 Major Depressive Disorder • Depression is often a response to past and current loss. • It is a type of psychic hibernation: slows us down, defuses aggression, and restrains risk taking. Rumination (define) can be adaptive: reassess, redirect energy 59 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. Maladaptive Signs include: Lethargy and fatigue Feelings of worthlessness Loss of interest in family & friends Loss of interest in activities 60 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 61 MOOD DISORDERS • Seasonal Affective Disorder (SAD) - 62 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 63 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 64 BIPOLAR DISORDER • Mild form of bipolar disorder: cyclothymia • Maladaptive symptoms of manic phase – Grandiose optimism and self-esteem – Reckless behavior – Loud, flighty, hard to interrupt speech 65 Subsets of Bipolar Disorder • Bipolar I: manic episodes may alternate with periods of deep depression or sometimes periods of relatively normal mood separate these extremes (also called manic depression). – Tends to be very rare • Bipolar II: major depressive episodes alternate with episodes known as hypomania, which are less severe than the manic phases seen in bipolar I disorder. • Cyclothymic Disorder: the bipolar equivalent of dysthymia; it involves episodes of depression and mania, but the intensity of both moods is less severe than in cases of bipolar I disorder. 66 MOOD DISORDERS • DISCOVERY: BIPOLAR VIDEO CLIP • http://player.discoveryeducation.com/index. cfm?guidAssetId=674E998C-928F-444CA85D-5C0897428F24 67 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. Behavioral and cognitive changes, including symptoms of other disorders such as delusions 2. Common causes of depression 68 Theory of Depression 3. Gender differences 69 Theory of Depression Desiree Navarro/ Getty Images 4. Depressive episodes usually selfterminate. 5. Stressful events often precede depression. 6. Depression is increasing, especially in the teens. Gene penetrance (define) or comfort level with reporting? 70 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 71 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. 72 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 73 Biology and Depression • Depressed people have lower levels in their diet and blood of a “good” fat: omega-3 fatty acid that enhances brain function 74 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 75 Social-Cognitive Perspective/SELIGMAN The social-cognitive perspective suggests that depression arises partly from self-defeating beliefs and negative explanatory styles. 76 Depression Cycle 1. Negative stressful events. 2. Pessimistic explanatory style. May arise from learned helplessness. 3. Hopeless depressed state. 4. These hamper the way the individual thinks and acts, fueling personal rejection. 77 Example Explanatory style plays a major role in becoming depressed. 78 RISE OF DEPRESSION EXPLAINED BY SELIGMAN • Due to epidemic hopelessness (preexisting pessimism encountering failure). • Hopelessness due to: rise of individualism decline of commitment to religion and family resulting self-blame with nothing to fall back on 79 Women and Depression • Women are more likely to suffer from depression • Women tend to think, often overthink (ruminate) when trouble arises • Differences in emotional memory (more vivid recall of bad experiences) 80 SOMATOFORM DISORDERS (not in textbook) • Somatoform disorder: psychological disorder in which the symptoms take a somatic (bodily) form without apparent physical cause • Two types of somatoform disorder – Conversion disorder – Hypochondriasis 81 SOMATOFORM DISORDER • Conversion Disorder: a rare somatoform disorder in which a person experiences very specific genuine physical symptoms for which no physiological basis can be found. • Hypochondriasis: a somatoform disorder in which a person interprets normal physical sensations as symptoms of a disease 82 Somatoform Disorders : Conversion Disorders differ from true physical disorders in 3 ways: 1. usually appear under severe stress, 2. allow person to reduce stress by avoiding unpleasant or threatening situations, and 3. the person may show little concern about what apparently should be a serious problem. Tend to be very rare 83 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 (1%)(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. 84 Symptoms of Schizophrenia The literal translation is “split mind.” A group of severe disorders characterized by the following: 1. Disorganized and delusional thinking. 2. Disturbed perceptions (hallucinations). 3. Inappropriate emotions (flat affect) and actions. 85 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”). 86 DELUSIONS • Delusions are NOT hallucinations! • Types: – Delusions of grandeur – Delusions of persecution 87 Disorganized & Delusional Thinking Many psychologists believe disorganized thoughts occur because of selective attention failure (fragmented and bizarre thoughts). 88 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 89 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). 90 Subtypes of Schizophrenia Schizophrenia is a cluster of disorders. These subtypes share some features, but there are other symptoms that differentiate these subtypes. Disruptions of language/thinking: word salads, neologisms (invent new words), clang associations (rhyming rather than meaning for word choice), thought blocking, thought insertion. Personal hygiene often suffers. 91 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). 92 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. 93 Subtypes 94 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. 95 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 96 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 97 Viral Infection Schizophrenia has also been observed in individuals who contracted a viral infection (flu) during the middle of their fetal development. 98 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 99 Genetic Factors The following shows the prevalence of schizophrenia in identical twins as seen in different countries. 100 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 suffer more than the others, thus there are contributing environmental factors. 101 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. 102 Personality Disorders (AXIS II) Personality disorders are characterized by inflexible and enduring behavior patterns that impair social functioning. They are usually without anxiety, depression, or delusions. 103 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. 104 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. 105 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 106 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). 107 Rates of Psychological Disorders 108 Rates of Psychological Disorders The prevalence of psychological disorders during the previous year is shown below (WHO, 2004). 109 INSANITY DEFENSE • Read: “The Insanity Defense: A Closer Look” • Skim over the John Hinckley packet. • Determine why John Hinckley received the sentence of not guilty by reason of insanity. Summarize this view; include in your answer your understanding of paranoid schizophrenia. Do you agree with the sentence? Why or why not? 110 Risk and Protective Factors Risk and protective factors for mental disorders (WHO, 2004). 111 Risk and Protective Factors 112