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Psychological Disorders Chapter 12 Psychological Disorders I felt the need to clean my room … would spend four to five hours at it… At the time I loved doing it. Then I didn't want to do it any more, but I couldn’t 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) 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. Psychological Disorders To study the abnormal is the best way of understanding the normal. William James (1842-1910) 1. There are 450 million people suffering from psychological disorders (WHO, 2004). 2. Depression and schizophrenia exist in all cultures of the world. 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). Deviant, Distressful & Dysfunctional Carol Beckwith 1. Deviant behavior (going naked) in one culture may be considered normal, while in others it may lead to arrest. 2. Deviant behavior must accompany distress. 3. 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. 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. John W. Verano Trephination (boring holes in the skull to remove evil forces) The Medical Model Philippe Pinel (1745-1826) from France, insisted that madness was not due to demonic possession, but an ailment of the mind. George Wesley Bellows, Dancer in a Madhouse, 1907. © 1997 The Art Institute of Chicago Dance in the madhouse. Medical Model When physicians discovered that syphilis led to mental disorders, they started using medical models to review the physical causes of these disorders. 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. The Biopsychosocial Approach Assumes that biological, socio-cultural, and psychological factors combine and interact to produce psychological disorders. Classifying Disorders and Labeling People 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. 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.” Labeling Psychological Disorders 1. Critics of the DSM-IV argue that labels may stigmatize individuals. Elizabeth Eckert, Middletown, NY. From L. Gamwell and N. Tomes, Madness in America, 1995. Cornell University Press. Asylum baseball team (labeling) Labeling Psychological Disorders 2. Labels may be helpful for healthcare professionals when communicating with one another and establishing therapy. Labeling Psychological Disorders Elaine Thompson/ AP Photo 3. “Insanity” labels raise moral and ethical questions about how society should treat people who have disorders and have committed crimes. Theodore Kaczynski (Unabomber) Anxiety Disorders Feelings of excessive apprehension and anxiety. 1. 2. 3. 4. 5. Generalized anxiety disorder Panic disorder Phobias Obsessive-compulsive disorder Post-traumatic stress disorder Generalized Anxiety Disorder Symptoms 1. Persistent and uncontrollable tenseness and apprehension. 2. Autonomic arousal. 3. Inability to identify or avoid the cause of certain feelings. 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. Phobias Marked by a persistent and irrational fear of an object or situation that disrupts behavior. Kinds of Phobias Agoraphobia Acrophobia Claustrophobia Hemophobia Phobia of open places. Phobia of heights. Phobia of closed spaces. Phobia of blood. Obsessive-Compulsive Disorder Persistence of unwanted thoughts (obsessions) and urges to engage in senseless rituals (compulsions) that cause distress http://www.youtube.com/watch?v=tPFQMRx2l 3Y 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 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 Bettmann/ Corbis 4. Jumpy anxiety 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. Dissociative Disorders 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. Dissociative Identity Disorder (DID) A disorder in which a person exhibits two or more distinct and alternating personalities, formerly called multiple personality disorder. http://www.youtube.com/watch?v=9X3r49yaml E Lois Bernstein/ Gamma Liason Chris Sizemore (DID) Personality Disorders Personality disorders are characterized by inflexible and enduring behavior patterns that impair social functioning. They are usually without anxiety, depression, or delusions. 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. 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. 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 (Raine et al., 1999; 2000). Courtesy of Adrian Raine, University of Southern California Normal Murderer Borderline Personality Disorder • A pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following: – – – – – – – – – Frantic efforts to avoid real or imagined abandonment. A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation Identity disturbance: markedly and persistently unstable self-image or sense of self Impulsivity in at least two areas that are potentially self-damaging (e.g., spending, sex, substance abuse, reckless driving, binge eating). Recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior. Affective instability due to a marked reactivity of mood (e.g., intense episodic dysphoria, irritability, or anxiety usually lasting a few hours and only rarely more than a few days). Chronic feelings of emptiness. Inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights). Transient, stress-related paranoid ideation or severe dissociative symptoms. http://www.youtube.com/watch?v=Qt9SOvILMI8 Substance-Related Disorders Psychoactive Drug: A chemical substance that alters perceptions and mood (affects consciousness). Tolerance, Addiction & Dependence Continued use of a psychoactive drug produces tolerance. With repeated exposure to a drug, the drug’s effect lessens. Thus it takes greater quantities to get the desired effect. Withdrawal & Dependence 1. Withdrawal: Upon stopping use of a drug (after addiction), users may experience the undesirable effects of withdrawal. 2. Dependence: Absence of a drug may lead to a feeling of physical pain, intense cravings (physical dependence), and negative emotions (psychological dependence). Misconceptions About Addiction Addiction is a craving for a chemical substance, despite its adverse consequences (physical & psychological). 1. Addictive drugs quickly corrupt. 2. Addiction cannot be overcome voluntarily. 3. Addiction is no different than repetitive pleasure-seeking behaviors. Psychoactive Drugs Psychoactive drugs are divided into three groups. 1. Depressants 2. Stimulants 3. Hallucinogens Depressants Depressants are drugs that reduce neural activity and slow body functions. They include: 1. Alcohol 2. Barbiturates 3. Opiates Depressants 1. Alcohol affects motor skills, judgment, and memory…and increases aggressiveness while reducing self awareness. Ray Ng/ Time & Life Pictures/ Getty Images Daniel Hommer, NIAAA, NIH, HHS Drinking and Driving Depressants 2. Barbiturates: Drugs that depress the activity of the central nervous system, reducing anxiety but impairing memory and judgment. Nembutal, Seconal, and Amytal are some examples. Depressants http://opioids.com/timeline 3. Opiates: Opium and its derivatives (morphine and heroin) depress neural activity, temporarily lessening pain and anxiety. They are highly addictive. Stimulants Stimulants are drugs that excite neural activity and speed up body functions. Examples of stimulants are: 1. 2. 3. 4. 5. 6. Caffeine Nicotine Cocaine Ecstasy Amphetamines Methamphetamines Caffeine & Nicotine Caffeine and nicotine increase heart and breathing rates and other autonomic functions to provide energy. http://office.microsoft.com/clipart http://www.tech-res-intl.com Why Do People Smoke? 1. People smoke because it is socially rewarding. 2. Smoking is also a result of genetic factors. Russel Einhorn/ The Gamma Liason Network Why Do People Smoke? 3. 4. Nicotine takes away unpleasant cravings (negative reinforcement) by triggering epinephrine, norepinephrine, dopamine, and endorphins. Nicotine itself is rewarding (positive reinforcement). Cocaine Cocaine induces immediate euphoria followed by a crash. Crack, a form of cocaine, can be smoked. Other forms of cocaine can be sniffed or injected. http://www.ohsinc.com Ecstasy Ecstasy or Methylenedioxymethamphet amine (MDMA) is a stimulant and mild hallucinogen. It produces a euphoric high and can damage serotonin-producing neurons, which results in a permanent deflation of mood and impairment of memory. Hallucinogens Ronald K. Siegel Hallucinogens are psychedelic (mindmanifesting) drugs that distort perceptions and evoke sensory images in the absence of sensory input. Hallucinogens Hemp Plant http://static.howstuffworks.com 1. LSD: (lysergic acid diethylamide) powerful hallucinogenic drug that is also known as acid. 2. THC (delta-9-tetrahydrocannabinol): is the major active ingredient in marijuana (hemp plant) that triggers a variety of effects, including mild hallucinations. Near-Death Experiences (From “Hallucinations” by R.K. Siegel. Copyright © 1977 Scientific American, Inc. All rights reserved.) After a close brush with death, many people report an experience of moving through a dark tunnel with a light at the end. Under the influence of hallucinogens, others report bright lights at the center of their field of vision. Drugs Summary Influences on Drug Use The graph below shows the percentage of US highschool seniors reporting their use of alcohol, marijuana, and cocaine from the 70s to the late 90s. Influences on Drug Use The use of drugs is based on biological, psychological, and social-cultural influences. Marijuana Use The use of marijuana in teenagers is directly related to the “perceived risk” involved with the drug. Influence for Drug Prevention and Treatment 1. Education about the long-term costs 2. Efforts to boost people’s self-esteem and purpose 3. Attempts to modify peer associations and teaching refusal skills Psychological Disorders Mood Disorders Major Depressive Disorder Bipolar Disorder Understanding Mood Disorders Mood Disorders Emotional extremes of mood disorders come in two principal forms. 1. Major depressive disorder 2. Bipolar disorder 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 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. Signs include: Lethargy and fatigue Feelings of worthlessness Loss of interest in family & friends Loss of interest in activities 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 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 Understanding 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, 1998) note that a theory of depression should explain the following: 1. Behavioral and cognitive changes 2. Common causes of depression Theory of Depression 3. Gender differences Theory of Depression 4. Depressive episodes self-terminate. 5. Stressful events often precede depression. 6. Depression is increasing, especially in the teens. Desiree Navarro/ Getty Images Post-partum depression Biological Influences 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. 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 Depression Cycle 1. Negative stressful events. 2. Pessimistic explanatory style. 3. Hopeless depressed state. 4. These hamper the way the individual thinks and acts, fueling personal rejection. Schizophrenia The literal translation is “split mind” which refers to a split from reality. A group of severe disorders characterized by the following: 1. Disorganized and delusional thinking. 2. Disturbed perceptions. 3. Inappropriate emotions and actions. Symptoms of Schizophrenia Positive symptoms: the presence of inappropriate behaviors (hallucinations, disorganized or delusional talking) Negative symptoms: the absence of appropriate behaviors (expressionless faces, rigid bodies) Disorganized & Delusional Thinking This morning when I was at Hillside [Hospital], I was making a movie. I was surrounded by movie stars … I’m Mary 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”). Disorganized & Delusional Thinking Many psychologists believe disorganized thoughts occur because of selective attention failure (fragmented and bizarre thoughts). 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 August Natter, Witches Head. The Prinzhorn Collection, University of Heidelberg Photos of paintings by Krannert Museum, University of Illinois at Urbana-Champaign Inappropriate Emotions & Actions A schizophrenic person may laugh at the news of someone dying or show no emotion at all (flat affect). Patients with schizophrenia may continually rub an arm, rock a chair, or remain motionless for hours (catatonia). Onset and Development of Schizophrenia Nearly 1 in 100 people suffer from schizophrenia, and throughout the world over 24 million people suffer from this disease (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. 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. 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. Abnormal Brain Activity Brain scans show abnormal activity in the frontal cortex, thalamus, and amygdala of schizophrenic patients. Paul Thompson and Arthur W. Toga, UCLA Laboratory of Neuro Imaging and Judith L. Rapport, National Institute of Mental Health 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 Viral Infection Schizophrenia has also been observed in individuals who contracted a viral infection (flu) during the middle of their fetal development. Genetic Factors The likelihood of an individual suffering from schizophrenia is 50% if their identical twin has the disease (Gottesman, 2001). 0 10 20 30 40 50 Identical Both parents Fraternal One parent Sibling Nephew or niece Unrelated Genetic Factors The following shows the prevalence of schizophrenia in identical twins as seen in different countries. Psychological Factors Psychological and environmental factors can trigger schizophrenia if the individual is genetically predisposed (Nicol & Gottesman, 1983). Courtesy of Genain Family Genain Sisters The genetically identical Genain sisters suffer from schizophrenia. Two more than others, thus there are contributing environmental factors.