Download Abnormal Psychology

Abnormal Psychology
What is Normal?
• Free from any mental disorder
• Sane
Abnormal Behavior
-inability to behave in ways that further the well
being of the individual and society
*Discomfort- Psychological/Physiological
*Deviance-Bizarre, unusual behavior
*Dysfunction-inability to complete tasks or
take responsibility
-any behavior that interferes with personal
growth
DSM-IV
• DSM-IV: Diagnostic and Statistical Manual
of Mental Disorders
– Accepted system of classification for mental
disorders
– Lists symptoms, not why
– Assessment is made on five axes to provide a
complete picture of the individual
DSM-IV
Five Axes
• Axis 1- Clinical Syndromes- major
diagnostic classification
– EX: DID, Affective, Psychosis
• Axis 2- Developmental and Personality
Disorders- gives an understanding of the
diagnosis in Axis 1.
– EX:Childhood, Borderline personality disorder
• Axis 3- Medical Conditions – physical
problems relevant to the mental disorder
– EX: Too much Dopamine=Schizophrenia, dementia
DSM-IV
Five Axes
• Axis 4- Psychosocial Stressors – All
potentially stressful events or enduring
circumstances that are relevant to your disorder
– EX: Death of loved one, loss of job, poverty
• Axis 5- Global Assessment of
Functioning – Clinician provides a rating of
the psychological, social, and occupational
functioning of the person
– EX: On a scale from 1-100
– 1=Danger to him/herself
– 90=Good in all areas
Abnormal Psychology
• Ideas to consider when looking at
abnormality
*Social Non-Conformity: failure in socialization
They do not follow the rules for social conduct.
*Context: Situation and where it takes place
***The most influential context---CULTURE!
Culture Bound Syndromes
• 1. Amok(Location- Malaysia, Laos,
Philippines) Symptoms: brooding,
outburst of violent behavior, aggressive,
homicidal
• 2. Ataque de nervios(Latinos from the
Caribbean) Symptoms: uncontrollable
shouting, attacks of crying, trembling,
verbal and physical aggression
Culture Bound Syndrome
• 3. Ghost Sickness(Am. Indian Tribes)
Symptoms- bad dreams, weakness,
preoccupation with death and the dead
• 4. Hwa-byung(Location Korea)
Symptoms- suppression of anger, no
yelling, look like you’re going to explode
• 5. Koro(Location South and East Asia)
Symptoms- sudden, intense anxiety during
which the penis or nipples recede into the
body. Can possible cause death
Major Psychological Disorders
• 1. Organic Mental Disorders – Problems
caused by known and verifiable brain
pathology (pathology=disease)
– A. Delirium- disturbance of consciousness
and changes in cognition
• Ex. Memory deficit, disorientation, language and
perceptual disturbances
– B. Dementia- memory impairment and
cognitive disturbances
• Ex. Aphasia, Apraxia, Agnosia, disturbances in
planning or abstracting, Alzheimers
Major Psychological Disturbances
• C. Amnestic Disorder- Memory
impairment
– Ex. Retrograde, Anterograde
• D. Toxic Effects of Poisons
– Ex. Severe emotional disturbances, memory
loss, can lead to death
Major Psychological Disturbances
• 2. Substance Use Disorders- Psychological
dependence on a mood or behavior altering
drug
– A. Abuse- Maladaptive pattern or recurrent use
extending over a period of 12 months and continuing
despite social, occupational, psychological, physical,
or safety problems.
– B. Dependence- Maladaptive pattern of use
extending over a 12 month period and characterized
by unsuccessful efforts to control use despite
knowledge of harmful effects; taking more of
substance than intended; tolerance; or withdrawal
– EX: Alcohol, opiates, barbiturates, benzodiazepines,
amphetamines, caffeine, nicotine, cocaine, marijuana,
LSD, PCP, Inhalants, heroin, ecstasy
Major Psychological Disturbances
• 3. Disorders Evident in Infancy,
Childhood, & Adolescence
– A. Mental Retardation
• 1. Significant sub-average general intellectual
function
– Ex. IQ score
• 2. Concurrent deficiencies in adaptive behavior
– Degree of independence lower than would be expected
by age or cultural group
• 3. Onset before 18 years of age
• 4. Levels and IQ range
– Mild, Moderate, Severe, Profound
Disorders Evident in Infancy,
Childhood & Adolescence
• B. Communication Disorders-Impairments in
communication
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1.
2.
3.
4.
Limited speech
Poor vocabulary
Unusual word order
Stuttering
• Reading Disorder-significant impairment of reading
accuracy, speed, or comprehension
– 1. Dyslexia
• difficulty identifying single words
• problems understanding the sounds in words, sound order, or
rhymes
• problems with spelling
• transposing letters in words
• omitting or substituting words
• poor reading comprehension
• slow reading speed (oral or silent)
Disorders Evident in Infancy,
Childhood and Adolescence
• C. Separation Anxiety-Constantly seek their
parents’ company and may worry too much
about losing them.
– Must display at least three of the following symptoms:
• Excessive anxiety about separation from the attachment
figure
• Unrealistic fear that the attachment figure will be harmed
• Reluctance to attend school
• Persistent refusal to go to sleep unless the attachment figure
is nearby
• Persistent avoidance of being alone
• Nightmares involving themes of separation
• Repeated physical complaints when separated
• Excessive distress when separation is anticipated
Disorders Evident in Infancy,
Childhood and Adolescence
• D. ADD (Attention Deficit Disorder)Distractible, inattentive, not completing
tasks
– ADHD (Attention Deficit Hyperactivity
Disorder)- impulsive, heightened motor
activity, interrupts
– Symptoms are present before age seven and
present in two or more settings (not just in
school)
Disorders Evident in Infancy,
Childhood, and Adolescence
• E. Oppositional Defiant Disorder
– Pattern of negativistic, hostile behavior, often
loses temper, argues with adults, defies or
refuses adult requests, does not take
responsibility for actions, angry, resentful,
often blames others, spiteful, and vindictive
– Symptoms present before age eight
Disorders Evident in Infancy,
Childhood, and Adolescence
• F. Autism-qualitative impairment in social
interaction, communication, restricted activities
• Symptoms:
– 1. 6 mos to 3 yrs of age onset
– 2. Social isolation- Ignore parents
– 3. Stereotyped behavior- rocking, bites hands, stares
at same object
– 4. Resistance to any change in routine
– 5. Abnormal responses to sensory stimuli
– 6. Remarkably insensitive to cuts, burns
– 7. Inappropriate emotional expressions
– 8. Poor development of speech
Disorders Evident in Infancy,
Childhood and Adolescence
• G. Tic Disorders (Tourette’s Syndrome)
– Symptoms:
– 1. Begins between ages two and thirteen
– 2. involuntary twitching
– 3. facial grimacing
– 4. head jerking
– 5. unusual sounds-hooting, barking, whirling
– 6. coprolalia-uncontrollable swearing
Major Psychological Disorders
• 4. Sleep Disorders
– Difficulty in initiating and maintaining sleep
– EX:
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2.
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5.
Insomnia
Apnea
Narcolepsy
Somnambulism
Sleep disruptions
Major Psychological Disorders
• 5. Impulse Control Disorders- failure to resist an
impulse or urge to act that is harmful to oneself
or to others
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–
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A. Kleptomania- urge to steal
B. Pathological Gambling- urge to gamble
C. Pyromania- urge to set fires
D. Intermittent Explosive- express strong, angry
feelings
– E. Trichotillomania- urge to pull one’s hair
– F. Sexual Impulsivity- (Nymphomaniac) urge to have
indiscriminate sex
Trichotillomania
Major Psychological Disorders
• 6. Eating Disorders- Characterized by physically
and/or psychologically harmful eating patterns
– A. Anorexia Nervosa-Refusal to maintain a body
weight above the minimum normal weight for one’s
age and height, intense fear of becoming obese, body
image distortion, absence of at least three menstrual
cycles otherwise expected to occur.
– B. Bulimia Nervosa- Recurrent episodes of binge
eating, loses control of eating behavior when binging,
uses vomiting, exercise, laxatives, or dieting to control
weight, two or more eating binges a week, occurring
for three or more months, over concern with body
weight and shape.
Eating Disorders
• More common among young
women than young men.
• More common among young
women working in fields that
especially emphasize weight
and appearance
• More common among middleand upper-class whites who
equate thinness with beauty
• More prevalent in
industrialized societies
• Higher among Arab and Asian
women who are living or
studying in Western countries
• 1 out of every 100 women age
10-20 has an eating disorder
• Each day Americans
spend an average of
$109 million on dieting
and diet related products.
Major Psychological Disturbances
• 7. Anxiety Disorders-Characterized by
persistent anxiety
– A. Generalized Anxiety Disorder – Excessive
anxiety and apprehension over a number of life circumstances
for a period of at least six months.
• i. Worry is difficult to control
• ii. Symptoms include
– Vigilance, muscle tension, restlessness, edginess,
difficulty concentrating
– B. Panic Attacks- recurrent and unexpected feelings of
anxiety (feel like you’re having a heart attack)
• i. Sweating, racing heart, dizziness, nausea,
intense fear, difficulty in breathing
• ii. Concern about expected future panic attacks or
about losing control
• iii. Can occur with or without agoraphobia
Anxiety Disorders
• C. Phobic Disorder – Persistent, unrealistic fears of
specific objects or situations
– i. Most common- agoraphobia (fear of public
spaces)
• Three broad categories
– Social- social or professional encounters
– Panic- overwhelming fear for no reason
– Specific- snakes, heights, etc
Phobias
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Acrophobia
Ailurophobia
Arachnophobia
Hydrophobia
Claustrophobia
Coulrophobia
Dishabliliophobia
Dentophobia
Gephydrophobia
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Gynephobia
Hemophobia
Necrophobia
Ophidiophobia
Philemaphobia
Thaasophobia
Xenophobia
• Arachibutyrophobia
• Triskaidekaphobia
• Hippopotomonstrosesqui
pedaliophobia
Anxiety Disorders
• D. Post-Traumatic Stress Disorder (PTSD)
– Re-experiencing a traumatic event through
recurrent and intrusive memories and dreams
– Ex: War, imprisonment, severe abuse, natural
disaster (hurricane, tsunami, earthquake),
accidental disaster (plane crash, bombing, etc)
– Symptoms: flashbacks, dreams, recurrent
recollections, persistent avoidance of stimuli
associated with the trauma, numbing of general
responsiveness, sleep difficulty, angry outbursts,
startled easily, difficulty in concentration
Anxiety Disorders
• E. OCD-Obsessive-Compulsive Disorder
– Having continued thoughts about performing a certain act over
and over
• 1. Obsessive-endless preoccupation with an urge or
thought
– Images or impulses that are experienced are either
inappropriate, intrusive and anxiety provoking
– Sufferer realizes that these thoughts are the product of their
mind
– Attempts to ignore or suppress them by thinking another thought
or performing some action
• 2. Compulsions-involve repetitive and rule following
behaviors (handwashing, cleaning) or mental acts
(counting, praying)
– Sufferer feels driven to perform to reduce stress or to avoid
imagined catastrophe
– Acts are excessive and not realistically linked with what the
sufferer is trying to avoid
OCD
• Obsession- A woman cannot rid herself of the
thought that she might accidentally leave her
gas stove turned on, causing her house to
explode
• Compulsion- Every day she feels the irresistible
urge to check the stove exactly 10 times before
leaving for work
________________________________________
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
to three steps up, followed by two steps down in
order to ward off danger
OCD
• 4 million Americans have OCD (makes it
more common than panic disorder and
even schizophrenia)
• Affects children, teenagers, and adults
• Occurs across all social and economic
levels
• 80% of all cases, it involves washing
rituals linked to contamination fears
Mood (Affective) Disorders
On the Dark Side of the Mood
• A. Unipolar Depression “common cold” of
mental illness
– 1. depressed mood or loss of pleasure
– 2. intense feelings of sadness or guilt (emotional)
– 3. passivity and great difficulty in initiating action or
making decisions (motivational)
– 4. Frequent negative thoughts, faulty attribution of
blame, low self-esteem (cognitive)
– 5. Loss of energy, restlessness (physical)
– 6. May last six or more months
• 12% of adult population will be affected by this
• Can turn into a major depressive episode
– Thoughts of suicide, death
Mood (Affective) Disorders
• B. Bipolar Depression-involves symptoms
of depression, followed by mania
– 1. Manic symptoms-abnormally euphoric,
elevated, or irritable mood
– 2. Increase in pleasurable activities that have
a high risk of painful consequences
– 3. Inflated self-esteem, racing ideas, and
thoughts
– 4. Decreased need for sleep
– 5. Lasting at least one week
Account of a Manic-Depressive
Episode
• “There is a particular kind of pain, elation,
loneliness, and terror involved in this kind of
madness. When you’re high it’s tremendous.
The ideas and feelings are fast and
frequent…Shyness goes, the right word and
gestures are suddenly there…There are
interests found in uninteresting people. Feelings
of ease, intensity, power, …But somewhere, this
changes. The fast ideas are far too fast and
there are far too many; overwhelming confusion
replaces clarity. Memory goes. ----you are
irritable, angry, frightened, uncontrollable, and
enmeshed totally in the blackest caves of the
mind. You never knew those caves were there.
It will never end, for madness carves its own
reality.”
Major Psychological Disorders
• 9. Somatoform Disorders-mental disorders in
which psychological symptoms take a
physical(somatic) form, even though no physical
causes can be found.
• A. Hypochondriasis-Individual has a pervasive
fear of illness and disease
– Ex. Calls the doctor for every little symptom, goes in
for a physical exam, when nothing is detected, will
call another doctor. Tend to be pill enthusiasts
• B. Conversion Disorder-Individual experiences
genuine physical symptoms, even though no
physiological problems can be found.
– Ex. May be unable to speak, become deaf or blind,
faint
Somatoform Disorders
• C. Factitious Disorders-People voluntarily
induce an actual physical condition or
simulate physical or mental conditions
– Ex. Drink Ipecac (emetic), purposefully slip
and fall, (Not Self-Mutilation)
– Munchausen’s syndrome-Extreme form of
factitious disorder
• When a person deliberately feigns or induces an
illness in another person
– Parents make their children ill in order to require
hospitalization
Somatoform Disorders
• D. Body Dysmorphic Disorder-involves a
preoccupation with some imagined defect in
appearance, in a normal-appearing person.
– Examples of Imagined Defects
• 1. excessive hair or lack of hair
• 2. size or shape of the nose, face or eyes
• 3. skin, acne, and blemishes
– Symptoms
• 1. frequent mirror checking
• 2. constant concern that others may be looking at their
“defect”
• 3. frequent requests for additional operations
• 4. avoid social activities, work and school
Major Psychological Disturbances
• 10. Dissociative Identity Disorder (AKA
Multiple Personality Disorder)-mental
disorders that involve a sudden loss of
memory or change in identity
• A. Psychogenic Amnesia-Memory loss
caused by extensive psychological stress
– Ex. Lose memory for both the distant and
recent past, lose their personal identity
(name, address, job) but general knowledge
remains intact, remembers events after the
amnesia starts
Dissociative Identity Disorders
• B. Fugue –Individual develops amnesia,
but also unexpectedly travels away from
home and establishes a new identity.
– Ex. Person shows up in new city, can’t
remember anything, lives with new identity.
What makes this real? Consistency!
• C. Dissociative Identity Disorder-Multiple
Personality Disorder- Individual has two or
more distinct/separate personalities
– Extremely rare
DID-Dissociative Identity Disorder
• 1. Most famous case-Chris Sizemore
– a. Three distinct personalities
• “Eve White”, “Eve Black” and “Jane”
• 2. Sybil-16 complete and totally different
personalities
• 3. Often, personalities are aware of some or all
of the others to a varying degree
• 4. In nearly all cases, the disorder has been
preceded by abuse (sexual, physical, and
emotional)
• 5. Occurs more frequently in woman than man
Sybil’s Personalities
• 1. Victoria Antoinette
Scharleau
• 2. Peggy Lou Baldwin
• 3. Peggy Ann Baldwin
• 4. Mary Lucinda
Saunders Dorsett
• 5. Marcia Lynn Dorsett
• 6. Vanessa Gail Dorsett
• 7. Mike Dorsett
• 8. Sid Dorsett
• 9. Nancy Lou Ann
Baldwin
• 10. Sybil Ann Dorsett
• 11. Ruthie Dorsett
• 12. Clara Dorsett
• 13. Helen Dorsett
• 14. Marjorie Dorsett
• 15. The Blonde
• 16. The New Sybil
DID-Dissociative Identity Disorder
• 6. When it goes to court!
– Kenneth Bianchi
• AKA “The Hillside Strangler” 1979 charges with murdering
two college women and implicated in several other rapemurder cases
• Created Steve and Billy
– Mark Peterson
• Was prosecuted for sexually assaulting a 26 yr old woman
who had 21 distinct personalities
• The Wisconsin jury had three issues to consider
– 1. whether Sarah was mentally ill at the time of the sexual act
– 2. whether she was able to appraise Peterson’s conduct
– 3. whether Peterson knew of Sarah’s condition
Major Psychological Disorders
• 11. Personality Disorders-Inflexible and
maladaptive personality traits that cause
significant functional impairment or
subjective distress for the individual.
– Three Categories
• 1. Odd, Eccentric
• 2. Anxious, Fearful
• 3. Dramatic, Emotional, Erratic
Personality Disorders
• A. Odd and Eccentric
• 1. Paranoid-Unwarranted suspiciousness,
hypersensitivity, reluctance to confide in others
– Ex. Overly suspicious, mistrusting, guarded
– More prevalent in males
• 2. Schizoid-Socially isolated, emotionally cold,
indifferent to others
– Ex. Tend to be loners; do not experience strong
emotions such as sadness, anger or happiness
– More prevalent in males
• 3. Schizotypal-Peculiar thoughts and behavior,
poor interpersonal relationships
– Ex. May report bizarre fantasies and unusual
perceptual experiences. Their speech may be slightly
difficult to follow
– More prevalent in males
(Travis Bickle-Taxi Driver)
Personality Disorders
• B. Anxious or Fearful
• 1. Avoidant-Fear of rejection and humiliation, reluctance
to enter into social relationships, hypersensitivity to
criticism or negative evaluation
– Ex. They want to be liked by others, have few if any friends,
extremely shy (not a social phobia)
– No gender difference
• 2. Dependent-Reliance on others and inability to
assume responsibilities, submissive, clinging
– Ex. Unable to make everyday decisions on their own, feel
anxious and helpless when they are alone
– No gender difference
• 3. Obsessive-Compulsive-Perfectionism, interpersonally
controlling, devotion to details
– Ex. Workaholics, so preoccupied with details and rules that they
lose sight of the main point. Judgmental
– More prevalent in males
Personality Disorders
• C. Dramatic, Emotional, or Erratic
• 1. Histrionic-Self-dramatization, exaggerated
emotional expressions, and attention-seeking
behaviors
– Ex. Thrive on being the center of attention; self
centered , vain, and demanding; inappropriately
sexually seductive or provocative
– More prevalent in women
• 2. Narcissistic- Exaggerated sense of selfimportance, lack of empathy
– Ex. Preoccupied with their own achievements and
abilities; consider themselves to be very special
– More prevalent in men
• 3. Borderline- Intense fluctuations in mood, selfimage, and interpersonal relations
– Ex. Form intense, unstable relationships; seen by
others as being manipulative; temper tantrums
– More prevalent in women
Personality Disorders
• 4. Antisocial (Psychopath or Sociopath)
– Characteristics
• 1. superficial charm and good intelligence
• 2. shallow emotions-lack of empathy, guilt or
remorse
• 3. behaviors indicative of little life plan
• 4. failure to learn from experiences
• 5. absence of anxiety
• 6. unreliability, insincerity, and untruthfulness
• 7. not diagnosed in children or adolescents
– Must be 18 or older
Antisocial Personality Disorder
• Dangerous?
– Depends on each person. Do you consider a
con-artist to be dangerous? Is a televangelist
dangerous?
– Not all Sociopaths are Serial Killers!
– They do tend to break laws and have a
reckless disregard for safety of self and others
• Treatment
– Rarely treated with success
– Manipulate therapy
Sexual and Gender Identity
Disorders
• What is “normal” sexual behavior?
– Personally fulfilling and mutually enjoyable for
both partners
• Sexual behavior is considered abnormal
when it results in personal distress or
when it involves non-consenting partners.
• How do we know so much?
– Masters and Johnson-best known sextherapists and researchers since the 60s
Sexual and Gender Identity
Disorders
• DSM-IV categories
• 1. Sexual Dysfunctions- inhibitions of
sexual desire and interference with
physiological responses leading to orgasm
• 2. Gender-Identity Disorders- a person
develops a strong and persistent
identification with the other gender
• 3. Paraphilias- people who are sexually
aroused by unusual things and situations
Sexual Dysfunctions
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2.
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Hypoactive sexual desire disorder
Sexual aversion disorder
Male erectile disorder
Female sexual arousal disorder
Male orgasmic disorder
Female orgasmic disorder
Premature ejaculation
Dyspareunia
Vaginismus
Gender-Identity Disorders
• Transsexualism- Some people are firmly
convinced that they are living in the wrong
kind of body.
• Ex. Males feel strongly that they are
women trapped in a man’s body.
• Discomfort with one’s anatomical sex
• Jenny Finney Boylan
• “She’s Not There: A Life in Two Genders”
Gender-Identity Disorders
• Gender Identity Disorder Not Otherwise
Specified
– Pseudohermaphroditism
• Genetically male, but are unable to produce a
hormone that is responsible for shaping the penis
and scrotum.
Paraphilias
• Pedophilia- Pre-pubescent
child
• Incest- immediate family
members
• Fetishism- inanimate objects
– Women’s underwear, boots,
rubber, leather etc
• Sadism- inflicting pain as part
of the sex act
• Masochism- receiving pain as
part of the sex act
• Exhibitionism- displaying the
genitals
• Voyeurism- viewing the
genitals of others without their
consent
• Frotteurism- rubbing or
touching genitals against
another, non-consenting adult
• Necrophilia- Corpses
• Zoophilia (Bestiality) animals
• Coprophilia- urine,feces
• Klismaphilia- enemas
• Telephone Scatologiaobscene phone calls
• Autoerotic Asphyxia- being
choked
• Nymphomania- indiscriminate
sex
Psychotic Disorders
• Psychotic Disorders AKA Schizophrenia
• Psychosis is a major loss of contact with
reality.
• Diagnosis in the DSM-IV
– 1. Two or more of the following symptoms
present for a significant amount of time in a
one month period.
Psychotic Disorders
• Symptoms
• A. Hallucinations-sensory experiences
that occur in the absence of a stimulus.
– Most common: auditory (hear voices)
– “insects crawling under your skin”; “taste
poisons in their food”
– See images, colors, etc that are not there
Psychotic Disorders
• B. Delusions-false beliefs that are held even
when the facts contradict them
– 1. Depressive- people feel that they have committed
horrible crimes or sinful deeds
– 2. Somatic- people believe that their bodies are
“rotting away”
– 3. Grandeur- individuals think they are extremely
important people
– 4. Reference- Unrelated events are given personal
significance
– 5. Persecution- People feel others are out to get
them
Psychotic Disorders
C. Disorganized Speech- incoherent
• D. Disorganized Behavior- repetitive
movements or gestures
• E. Negative symptoms- flat affect
(emotional blunting)
– Voice is often monotonous, face is frozen
• 2. Disturbance must last for six months
• Marked deterioration in functioning at
work, social relations, and in self care
Psychotic Disorders
Symptoms
• 1. Emotional
– Flat, unresponsive
– Inappropriate to the situation
• 2. Behavioral
– Psychomotor agitation-fixed repetitive gestures
– Catatonic stupor-keeping the same position for long periods of time
• 3. Perceptual
– Auditory hallucinations-hearing voices
– Visual hallucinations- size, space, and color distortions
• 4. Cognitive Disruption
– Distractibility-unable to maintain a consistent train of thought
– Attentional deficits-focusing on irrelevant stimuli
– Thought passivity-think others block, insert, or withdrew the thoughts
in their head
– Thought content-delusions
Subtypes of Schizophrenia
• 1. Residual or Borderline- gradual
development of minor problems
– Unusual behavior, social withdrawal,
emotional blunting, and apathy
– Avoids contact and communication with
others
– Age of onset is in the early 20s, for both
males and females
Subtypes of Schizophrenia
• 2. Catatonic- Stuporous condition or
prolonged, frenzied even violent behavior
– Rare in the United States, more prevalent in
non-Western countries
– Age of onset is in the late teens to early 20s
• 3. Disorganized- Personality
disintegration is almost complete
– Incoherent thoughts and speech
– Bizarre delusions and hallucinations
– Inappropriate emotions and behavior
– More common in females
– Age of onset is mid to late teens
Example of Catatonic
Schizophrenic
• Manuel appeared to be physically healthy upon
examination. Yet, he did not regain his
awareness of his surroundings. He remained
motionless, speechless, and seemingly
unconscious. One evening an aide turned him
on his side to straighten out the sheet, was
called away to attend to another patient and
forgot to return.
• Manuel was found the next morning still on his
side, his arm tucked under his body. His arm
was turning blue from lack of circulation but he
seemed to be experiencing no discomfort.
Example of Disorganized
Schizophrenic
• Excerpt from the intake interview of the disorganized schizophrenic
• Dr.- “I am Dr. Jones. I would like to know something more about
you.”
• Patient- “You have a nasty mind. Lord! Lord! Cat’s in a cradle”
• Dr.- “Can you tell me how you feel?”
• Patient- “London’s bell is a long, long, dock. Hee Hee (giggles
uncontrollably)
• Dr- “Do you know where you are now?”
• Patient- “D^%$ S&)% on you all who rip into my internals! The
grudgerometer will take care of you all. (Shouting) I am the Queen,
see my magic. I shall turn you all into smidgelings forever.”
• Dr.- “Your husband is concerned about you. Do you know his
name?”
• Patient- “Who am I? Who are we? Who are you? Who are they. I, I,
I, (makes grotesque faces)
• Edna was placed in the woman’s ward of a state mental hospital.
She masturbated in her cell. Occasionally she would scream or
shout obscenities. She was known to attack other patients. She
began to complain that her uterus was attached to a pipeline to the
Kremlin and she was being infernally invaded by Communism
Subtypes of Schizophrenia
• 4. Paranoid- involved organized and
complete delusions, auditory
hallucinations and relatively few other
symptoms
– Most common type
– Found equally in men and women
– Age of onset if in the 30s
Subtypes of Schizophrenia
• 5. Undifferentiated- Shows prominent
psychotic symptoms that do not meet the
criteria for the paranoid, disorganized, or
catatonic categories
– Sometimes turns out to be an early stage of
another subtype
– Found equally in men and women
– Age of onset if in the early 20s
Example of Undifferentiated
Schizophrenia
• Her husband found her twirling around the living room
bizarrely draped in her wedding gown, tied with a towel,
and wearing a lampshade. She happily greeted him,
laughed with an ear-piercing shrillness and invited him to
stay for the exciting “coming out” party she was giving.
Strewn on the table were a thousand handwritten
invitations addressed to such dignitaries as the President
of the US, justices of the Supreme Court, the Emperor of
Japan. She made noises, shouting her own poems,
made rhyming sounds, and yelled obscenities. Her
husband brought her to the hospital because she
refused to eat for 3 days. She spent long hours staring
off into space. In slow, monotonous speech, she
commented that she was talking to her dead sister who
was wearing a white gown. The face was eaten up by
worms and her eye socket was missing. She had
communications with God that centered around a
mixture of pleading with Him to do something about her
sister and reprimanding Him for letting her get that way.
What causes Schizophrenia?
• 1. Heredity
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Identical twins- 50%
Both parents- 45%
One parent and one sibling- 17%
One brother or one sister- 10%
• 2. Biochemistry
– Dopamine hypothesis- excess dopamine activity at certain
synaptic sites
• 3. Brain Structure
– Enlarged ventricles (MRIs)
– Cognitive Mapping
• 4. Environment
– Double bind theory- Child receives contradictory messages from
one or more family member (Sybil)
– Expressed emotion (EE)- negative communication pattern
(criticism/hostility)
– Unusual stresses
Treatment for Schizophrenia
• A. Antipsychotic Medication
– Reduces symptoms
– Dosage levels should be carefully monitored
– Side effects can occur as a result of
medication
– Ex: Thorazine, phenothiazines, neuroleptics,
Clozapine, Olanapine
– Three major classes of drugs are used
• Minor tranquilizers(calm the agitated person),
major tranquilizers(control hallucinations), and
antidepressants(improve the mood)
Treatment for Schizophrenia
• Psychosocial Therapy
– Institutional Approaches
• Group Therapy (milieu therapy)
• One on One
• Cognitive Behavioral Therapy
• Most clinicians agree that the most
beneficial treatment for schizophrenia is
some combination of antipsychotic
medication and therapy
In the past, other forms of
treatment for patients
• 1. ECT-Electroconvulsive Shock Therapy150 volt current that passes through the
brain.
• 2. Insulin Shock Therapy-Insulin injected
into the patients body, drastically reducing
the blood sugar level.
• 3. Psychosurgery
– Prefontal lobotomy
– Transorbital lobotomy
– Lobectomy
– Cauterization
Something to think about
• Should patients have the right to refuse
medication?