Download Psychological disorders

PSYCHOLOGICAL
DISORDERS
FEM 4100
Brain and human behaviour
Outline
• Psychological disorders
• Mood disorders
• Somatoform disorders
• Anxiety disorders
Psychological Disorder (1/4)
• Refers to psychological or physiological pattern that is
usually associated with distress or disability that is not
expected as part of normal development of culture.
• Dysfunction in psychological disorders are assumed to be
the product of disruptions of thought, feelings,
communication perception and motivation.
• Not every dysfunction leads to a disorder, only those that
result in significant harm.
Psychological Disorder (2/4)
• There is no single accepted or consistent cause of
psychological disorders.
• Over one third of people in most countries reporting
sufficient criteria at some point in their life.
• How do we diagnosis with mental health:
• Using different methodologies – case history and interview
• How we treat mental patient?
• Psychotheraphy and psychiatric medication, supportive
interventions
• Treatment may be volunteer or involuntary when it is required by
law
• Widespread problems with stigma and discrimination
Psychological Disorder (3/4)
• Jerome Wakefield propose the idea of mental disorder
as ‘harmful dysfunction’, meets tow criteria:
• The condition causes harm according to social values of a persons
culture (suffering, unable to work) and;
• The condition results from and underlying mechanism that fails to
perform according to its natural fuctnion.
• Characteristics include:
• Present distress (painful symptoms)
• Disability (impairment in important areas of functioning); and
• Significantly increased risk of suffering pain, death, disability or loss
of freedom.
Psychological Disorder (4/4)
• Insanity – a legal term that refers to judgement about whether a
person should be held responsible for criminal behaviour if
he/she is mentally disturbed.
• Define abnormal behaviour in terms of statistical norms – how
common or rare it is in general population
• Prevalance of psychological disorder:
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Major depression 5%
Bipolar 1.2%
Schizophrenia 1.1%
Panic disorder 1.7%
OCD 2.3%
Generalised anxiety disorder 2.8%
Social phobia 3.7%
Agoraphobia 2.2%
Specific phobia 4.4%
MOOD DISORDERS
• Is a condition whereby the prevailing emotional mood is
distorted or inappropriate to the circumstances.
• Characterised by extreme and unwarranted disturbances in
emotion or mood
• Two major types of mood disorder: Depression (or unipolar
depression) and Bipolar disorder
• Depression - marked by feelings of great sadness, despair and
hopelessness as well as the loss of the ability or experience
pleasure.
• Types of Depression:
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Major depression
Major depression (recurrent)
Major depression with psychotic symptoms (psychotic depression)
Dythymia
Postpartum depression
• Bipolar disorder – a mood disorder formerly known as
‘manic depression’ and described by alternating periods of
mania and depression
• Subtypes include:
• Bipolar I
• Bipolar II
• Cyclothymia
• Rate of depression:
• Twice as likely among female compared to male
• Reasons: Conflicting roles of wife, lover and friend
• Boys – twice as likely before puberty, Female – twice as likely after
puberty
• More severe consequences among women.
Major Depressive Disorder - Symtpoms
• Changes in appetite, weight or sleep pattern
• Loss of energy
• Difficulty in thinking or concentrating
• Psychomotor disturbance
• Slowed body movements, reaction time and speech or
• Constant movement, fidgeting, wringing of hands and pacing
• Psychotic depression when severe
• Delusions or hallucinations
• Major depressive disorder lasts 1 year after initial diagnosis.
• Generally, about 40% of patients are without symptoms, 40% are still
suffering with the disorder
• 20% are still depressed but not enough to warrant hospitalisation.
• Less than half of hospitalised patients are fully recovered.
Major Depressive Disorder - Treatments
• Many receive antidepressant drugs.
• Studies reflect psychotheraphy is equally effective.
• 50% - 60% have recurrence; recurrence greatest for females
and when initial onset is before 15.
• 20% - 35% of patients recurrence is chronic-lasting more than
2 years.
• What are preventive measures?
• Medication, Psychotheraphy
• Social support & Exercise
• Medications:
• Selective serotonin reuptake inhibitors (SSRIs)
• Tricyclics (TCAs)
• Monoamine oxidase inhibitors (MAO-Is)
• Most recently developed drugs
Bipolar Disorder
• Manic episodes alternate with periods of depression
usually with relatively normal periods in between.
• Manic episode:
• Excessive euphoria
• Inflated self esteem
• Wild optimism
• Hyperactivity
• Temporarily lose touch with reality
• Frequently have delusions of grandeur along with euphoric highs
• May waste large sums of money on get-rich schemes
• Likely become irritable, hostile, enraged or dangerous if stopped
• May be hospitalised to protect themselves from disastraous
consequences
Bipolar disorder - Prevalance
• Affect 1.2% of the population
• Equal prevalance among male and female
• More than 90% have recurrences
• 50% have within a year recovery rate
• 70% to 80% return to a state of emotional stability
Effects:
• Mild cognitive deficits following manic episodes
• Many manage disorders and live normal life with the aid
of medication.
• Psychotheraphy helps to cope with stress of chronic
mental illness.
Causes of Mood Disorders
1) Biological factors
• Heredity and abnormal brain structure ad chemistry
• Abnormal levels of serotonin linked to depression and suicide;
• Production, transport and reuptake patterns of dopamine,
GABA and norepinephrine different than normal people;
• Neurotransmitter abnormalities may reflect genetic variations.
• Heritability of depressive disorder – 70%; followed by 30%
environment;
• 50% of identical twins & 7% of fraternal twins
• Biological relatives of bipolar disorder sufferers, tend to report
higher risk of other mental disorder
Depression can be caused by a lack of
the neurotranmitter serotonin in the
brain.
Mnny people are taking SSRIs such as
Prozac or Zoloft.
The other reason for depression caused
by a chemical imbalance is it’s caused
by a lack of the dopamine in the brain.
The type of depressive-feeling caused
by a lack of dopamine in the brain is a
very low energy depression, with a
complete lack of motivation, (and feeling
depressed).
You may feel frustrated that you don't
have any energy.
Causes of Mood Disorders
2) Cognitive factors
• Depressive individuals view themselves, the world, and
future in a negative way.
• Interactions are seen as a series of burdens and obtacles
that end in failure.
• How they think?
• ‘Everything turns our wrong.’
• ‘I never win’ or ‘it’s no use’
• ‘Things will never get better’
Causes of Mood Disorders
3) Life stressors
• Vast majority of depression occurs after major life stress.
• Women more likely to experience a severe negative life
events just prior to onset of depression.
• However, people with biological predisposition is different
(recurrences without major negative live events/stressors)
• Mood disorders is major risk for suicidal in all age groups,
especially when exposed to life stressors.
• Suicidal behaviour runs in families.
• More likely among women than men; older people are at
greater risk than younger.
SOMATOFORM DISORDERS
• Also known as Briquet’s syndrome
• Charaterised by physical symptoms that mimic disease or
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injury for which there is no identifiably physical cause or
physical symptoms such as pain, nausea, depression and
dizziness.
Physical symptoms present due to psychological causes rather
than any known medical condition.
People with somatoform disorders – not faking illness to avoid
work or other activities.
No general medical condition, other mental disorder or
substance is adequately diagnosed.
Complaints are serious enough to cause – significant emotional
distress, impairment of social and occupational functioning.
Implied psychological disorders, not the result of conscious
malingering or factitious disorders.
1) Hypochondriasis
• Persons are preoccupied with their health and fear that
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their physical symptoms are a sign of some serious
disease despite of reassurance from doctors;
Not convinced when medical examination reveals no
problem.
Symptoms are not consistent with known physical
disorders;
May ‘doctor shop’ seeking confirmation of their worst fear
Not easily treated with a poor chance of recovery.
2) Conversion Disorder
• A person suffers a loss of motor or sensory functioning in
some part of the body.
• The loss has no physical cause but solves some
psychological problem.
• May become blind, deaf, unable to speak or paralysis in
some part of the body.
• Sigmund Freud believes that it is an unconscious process
to help solve an unconscious sexual or aggressive
conflict.
3) Dissociative Disorder
• Disorders which, under unbearable stress, consciousness
becomes dissociated from a person’s identity or his/her
memories of important personal events or both.
a) Dissociative Amnesia
• A complete or partial loss of the ability to recall personal
information or identity past experiences which cannot be
attributed to forgetfulness or substance abuse.
• Cause: traumatic experience or a situation creating
unbearable anxiety causing the person to escape by
‘forgetting’
• However, they do not forget how to carry out routine task
and basic personality remain intact.
b) Dissociative fugue
• A complete loss of memory of one’s entire identity
• May assume a new identity that is more outgoing and
uninhibited than their former identity.
• Usually a reaction to a severe psychological stress.
• May last hours or months and may have no memory of
initiating stressors or events during the episode.
c) Dissociative Identity Disorder (DID)
• Two or more distinct, unique personalities occur in the same
person;
• Severe memory disruption concerning personal information
about the other personalities.
• 50% of cases there are more than 10 personalities.
• Usually, change occurs during sudden and during stress; host
personality is one in charge of body most of the time.
Alter personalities:
• Radical difference in intelligence, speech, accent, vocabulary,
posture, body language, manners, had writing and sexual
orientation etc.
• 80% host personality doesn’t know alter personality BUT alter
personalities have varying levels of awareness of each other.
• Lost time: Periods with no memory when in alter personality.
ANXIETY DISORDERS (AD)
• AD all have unrealistic, irrational fears or anxieties of
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disabling intensity; frequent fearful thoughts aobut what
might happen in the future.
Comprised of several different forms of abnormal,
pathological anxiety, fears, phobias.
It describes nervous system disorders as irrational or
illogical worry not based on fact.
Based on Diagnostic and Statistical Manual of mental
Disorders (DSM-IV-TR),
Phobia = persistent or irrational fear
Fear = an emotional and physiological response to a
recognised external threat.
ANXIETY DISORDERS
• Anxiety is an unpleasant emotional state.
• Often accompanied by physiological symptoms such as
fatigue or exhaustion.
• Crucial to distinguish different anxiety disorders –
accurate diagnosis is more likely to result in effective
treatment and a better prognosis.
• Types of Anxiety Disorder:
• Generalised anxiety disorder
• Panic attacks
• Phobias
• Obsessive-Compulsive Disorder (OCD)
Generalised Anxiety Disorder
• Plagued with chronic worry for 6 months or more
• Causes: Problems with finances, health, work or ability to
function socially
• Affects twice as many women as men.
• Treatment: Antidepressant drugs and cognitive and
behavioral therapies
• Symptoms:
• Feeling tense, tired and irritable
• Trembling, palpitations, sweating, dizziness, nausea and diarrhea
Panic Attacks
• An episode of overwhelming anxiety, fear or terror.
• 2% of men and 5% of women in US.
• Treatment: Medication and psychotheraphy
• Symptoms:
• A pounding heart
• Uncontrollable trembling or shaking
• Sensations of choking or smothering
• Feeling as if you are going to die
• Feeling as if you are going crazy
• The more catastrophic the belief, the more intense the panic
• Reccuring panic attack may be diagnosed with panic disorder
• Increased risk for abuse or alcohol and other drugs
Phobias
• Phobia
• An irrational, intense, persistent fear of certain situations, activities,
things or persons.
• Symptom:
• Excessive, unreasonable desire to avoid the feared subject
• Fear is beyond one’s control; interfering with one’s life
• Life is planned around avoiding feared situations – may
not leave home unless accompanied by a frined, family
member or when severe, not even then.
• Affects physical, psychological, social, occupational and
interpersonal and economic areas of life.
• Gender differences: Women 4 x more likely
• Begins typically in early adult years with panic attacks.
Types of Phobia
Social phobia:
• An irrational fear and avoidance of any social or performance situation in
which one might embarrass or humiliate oneself in front of others by
shaking, blushing. Sweating or appearing clumsy, foolish or incompetent.
• Performance anxiety: Speaking in public, Performance at work,
education or social life,
• Turn to alcohol or tranquilizers to reduce symptom’s affect.
Specific phobia (ranked by frequency of occurrence):
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Situational phobias (elevators, airplanes, enclosed places, tunnels)
Fear of natural environment (storms or water)
Animal phobias (dogs, snakes, mice etc.)
Blood injection-injury phobia (fear of seeing blood or receiving
injection)
Claustrophobia (closed spaces) and acrophobia (heights) most often
treated or a panic attack.
Causes of phobias
• Combinations of external events and internal predispositions.
• Can be traced back to specific triggering event (ie traumatic
experience at an early age)
• Heredity
• Heredity, genetics and brain chemistry combine with life experiences
play a major role in the development of anxiety disorders and phobias.
• May be caused by direct conditioning, modeling or the
transmission of information or traumatic childhood experience
with feared object (ie dog) or situation (ie drowning in a
swimming pool)
• Treatment:
• Classical conditioning: Help patients associate pleasant emotions with
feared items.
• Behaviour modifications: patients are reinforced for exposing
themselves to fearful stimuli
• Modelling: Observing people who do not fear to the situation of object
Obsessive-Compulsive Disorder (OCD)
• Characterised by a subject’s obsessive, distressing,
intrusive thoughts and related compulsions (tasks or
rituals) which attempt to neutralise the obsessions.
• A person suffers from recurrent obsession or compulsions
or both.
• A person who shows sign of infatuation or fixation with a
subject/object, or displays traits such as perfectionism –
does not necessarily have OCD.
• To be diagnosed with OCD,
• One must have with either obsessions or compulsions alone, or
obsessions and compulsions, according to DSM-IV-TR.
Obsessions are defined by:
• Recurrent and persistent thoughts, impulses or images –
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intrusive, inappropriate and 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 such thoughts,
impulses or images or to neutralise them with some toher
thought or action.
The person recognises that the obsessional thoughts,
impulses or images are a product of his/ her own mind
and are not based in reality.
Worries of:
• Contamination by germs; Whether they performed a specific action;
• Turning off the stove or locking the door; Aggression; Religion; Sex
Compulsion are defined by:
• Repetitive behaviours or mental acts that the person feels
driven to perform in response to an obsession, or according to
rules that must be applied rigidly.
• Behaviours or acts are aimed at preventing or reducing distress
or dreaded events or situation
• BUT they are not connected in a realistic way.
A person with OCD:
• Know the act is senseless but cannot resist to perform without
experiencing intolarable anxiety
• Anxiety is only relieve by doing the action
• Act is very time-consuming (ie taking up more than 1 hour per
day)
• Act interferes with normal activities and relationships with
others.
Obsessive-Compulsive Disorder (OCD)
• Often causes feelings similar to those of depression
• 75% of OCD involve cleaning or checking
• Sometimes, reflect superstitious thinking that msut be done to
ward off danger
• Occurs 2% - 3% in different countries such as US, Canada,
Korea, Germany, New Zealand and Puerto Rico.
Treatment:
• Behavioral treatment combine exposure and response
prevention – Clients repeatedly expose to stimuli that will
provoke obesession – prevent them from engaging in rituals.
• Medications – Serotonin (i.e. Prozac, Anafranil) –
Disadvantage: Relapse very high once medication is
discontinued.
CONGRATULATIONS!
You have completed all your classes for Brain
and Human Behaviour (FEM 4100)