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Introduction to Psychological Disorders “To study the abnormal is the best way to understand the normal” Psychological Disorder Mental health workers label thoughts, feelings and actions disordered when they are: maladaptive unjustifiable disturbing atypical INSANITY IN THE COURTS Insanity is a legal term The insanity plea is used in situations where the defendant is judged to be incapable of knowing right from wrong because of a mental disorder. Not placed in prisonmental hospital JOHN HINKLEY, JR. – ASSASSINATION ATTEMPT OF PRESIDENT REAGAN IN 1981 Not guilty by reason of insanity mental hospital Jeffrey Dahmer Serial killer & sexual offender Sane and found guilty prison EARLY MENTAL HOSPITALS • They were nothing more than barbaric prisons. •The patients were chained and locked away. SUPERNATURAL MODEL • Belief that abnormal behavior is caused by possession by gods, demons, or the devil • A full moon • Trephining Medical Model concept that diseases have physical causes can be diagnosed, treated, and in most cases, cured CURRENT PERSPECTIVES Bio-Psycho-Social Perspective: assumes biological, psychological and sociocultural factors combine to interact causing psychological disorders. Used to be called Diathesis-Stress Model: • diathesis meaning predisposition and • stress meaning environment. CLASSIFYING PSYCHOLOGICAL DISORDERS DSM-IV (TR) (4th ed., Text Revision) American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders widely used system for classifying psychological disorders MULTIAXIAL CLASSIFICATION OF THE DSM IV Axis I Axis II Axis III Axis IV Axis V 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, hypertension or arthritis etc) also present? Are Psychosocial or Environmental Problems (school or housing issues) also present? What is the Global Assessment of the person’s functioning? •Axis I •Adjustment Disorders Anxiety Disorders •Cognitive Disorders •Dissociative Disorders •Eating Disorders •Factitious Disorders •Impulse Control Disorders •Mood Disorders •Psychotic Disorders •Sexual and Gender Identity Disorders •Sleep Disorders •Somotoform Disorder •Substance-Related Disorders LABELING PSYCHOLOGICAL DISORDERS Labels can be helpful for health care professionals, communicating with one another and establishing therapy. David Rosenhaun (1973): went to mental hospital complaining of hearing Diagnosed with mental illness Help changed standards NEUROTIC DISORDERS • Distressing but one can still function in society and act rationally PSYCHOTIC DISORDERS • Person loses contact with reality, experiences distorted perceptions Charles Manson Son of Sam ANXIETY DISORDERS • A GROUP OF CONDITIONS WHERE THE PRIMARY SYMPTOMS ARE ANXIETY OR DEFENSES AGAINST ANXIETY. • the patient fears something awful will happen to them. ANXIETY DISORDERS 1. 2. 3. 4. 5. Generalized anxiety disorders Panic disorders Phobias Obsessive-compulsive disorders Post Traumatic Stress Disorder • An anxiety disorder in which a person is continuously tense, apprehensive and in a state of autonomic nervous system arousal. GENERALIZED ANXIETY DISORDER The patient is constantly tense and worried, feels inadequate, is oversensitive, can’t concentrate and suffers from insomnia. • An anxiety disorder marked by a minuteslong episode of intense dread in which a person experiences terror and accompanying chest pain, choking and other frightening sensations. • person experiences sudden episodes of intense dread. PANIC DISORDER PHOBIA • is an irrational, intense and persistent fear of certain situations, activities, things, animals, or people ophidiophobia arachnophobia Coulrophobia KINDS OF PHOBIAS Social Phobia Agoraphobia Phobia of open places. Specific Phobia Acrophobia Phobia of heights. Claustrophobia Phobia of closed spaces. SOME UNUSUAL PHOBIAS(SPECIFIC) • Ailurophobia - fear of cats • Algobphobia - fear of pain • Anthropophobia - fear of men • Monophobia - fear of being alone • Pyrophobia - fear of fire • Coulrophobia – fear of clowns • Arachityrophobia – fear of peanut butter sticking to the roof of one’s mouth • Triskaidekaphobia – fear of #13 OBSESSIVE-COMPULSIVE DISORDER •Persistence of unwanted thoughts •obsessions •urge to engage in senseless rituals •Compulsions •that cause distress. Common Obsessions Common Compulsions Contamination fears of germs, dirt, etc. Washing Imagining having harmed self or others Repeating Imagining losing control of aggressive urges Checking Intrusive sexual thoughts or urges Touching A need to tell, ask, confess Counting Forbidden thoughts Ordering/arranging A need to have things "just so" Hoarding or saving Praying POST-TRAUMATIC STRESS DISORDER • Victims of traumatic events experience the original event in the form of dreams and flashbacks • Common in military veterans, survivors of natural disasters, plane/car crashes, and human aggression Haunting memories. Nightmares. Social withdrawal Jumpy anxiety Sleep problems. Module 47 Dissociative and Personality Disorders DISSOCIATIVE DISORDERS disorders in which conscious awareness becomes separated (dissociated) from previous memories, thoughts and feelings. sudden loss of memory or change in identity • This disorder is characterized by a blocking out of critical personal information, usually of a traumatic or stressful nature. DISSOCIATIVE AMNESIA • An individual suddenly and unexpectedly takes physical leave of his or her surroundings DISSOCIATIVE FUGUE •in a fugue state: unaware of or confused about his identity, and in some cases will assume a new identity (rare!) DISSOCIATIVE IDENTITY DISORDER A rare dissociative disorder in which a person exhibits two or more distinct and alternating personalities. •3 Faces of Eve •Also called multiple personality disorder. PERSONALITY DISORDERS disorders characterized by inflexible and enduring behavior patterns that impair social functioning Need not involve anxiety, depression or loss of contact w/reality PERSONALITY DISORDERS Dennis Rader – BTK Bind, Torture & Kill Rader was a deacon who tortured animals as a child Antisocial Personality Disorder disorder in which the person (usually man) exhibits a lack of conscience for wrongdoing Lie, cheat, steal & unrestrained sexual behavior Express little regret Module 48 Mood Disorders MOOD DISORDERS characterized by emotional extremes. • Dysthymic/Cyclothymic Disorder • Major Depressive Disorder •Seasonal Affective Disorder •Bipolar Disorder 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. Signs include: 1. Lethargy and tiredness 2. Feelings of worthlessness 3. Loss of interest in family & friends 4. Loss of interest in activities WHO SUFFERS FROM DEPRESSION? • Depression can effect anyone but there is a significantly higher rate of depression among women than men. • 17 million Americans develop depression each year. • 8.6% of adults over 18 have a mental health problem for at least 2 weeks a year. WHAT IS DEPRESSION? • Depression is an illness that involves the body, mood and thoughts • It impacts the way a person functions socially, at work, and in relationships. • It is more than feeling blue, down in the dumps or sad about a particular issue or situation. • It is a medical condition that requires diagnosis and treatment DYSTHYMIC DISORDER •lies between blue mood and major depressive disorder. •A disorder characterized by daily depression lasting two years or more. •No manic episodes Blue Mood Dysthymic Disorder Major Depressive Disorder DYSTHYMIA • People with this illness are mildly depressed for years. • They function fairly well on a daily basis but their relationships suffer over time. • Dysthymic disorder: • “down in the dumps” mood most of day • Chronic low energy & self-esteem • Difficulty making decisions/concentration • Sleep/eattoo little or too much • Less disabled than major depression • Manic Episode marked by a hyperactive, wildly optimistic state • Cyclothymic Disorder: mood disorder lasting a year • Include numerous manic epidsodes SEASON AFFECTIVE DISORDER • This is a depression that results from changes in the season. Most cases begin in the fall or winter, or when there is a decrease in sunlight. Bipolar Disorder a mood disorder in which the person alternates between the hopelessness and lethargy of depression and the overexcited state of mania formerly called manic-depressive disorder BIPOLAR DISORDER Depressive Symptoms Manic Symptoms Gloomy Elation Withdrawn Euphoria Inability to make decisions Desire for action Tired Hyperactive Slowness of thought Multiple ideas BIPOLAR DISORDER The Rich and Famous CAUSES OF MOOD DISORDERS BIOLOGICAL PERSPECTIVE Genetic Influences: Mood disorders run in families. Rates of depression is higher in identical (50%) than fraternal twins (20%). Linkage analysis and associations studies link possible genes and dispositions for depression. NEUROTRANSMITTERS & DEPRESSION Reduction of norepinephrine and serotonin has been implicated in depression. Pre-synaptic Neuron Norepinephrine Serotonin Post-synaptic Neuron SOCIAL-COGNITIVE FACTORS • Depression may be a variation of learned helplessness. (Seligman) • Negative cognitive styles (Beck) THE DEPRESSION PUZZLE • 1. negative stressful events interpreted through…(money problems) • 2. a pessimistic explanatory style create…(blame yourself) • 3. a hopeless, depressed state that…(depressed mood) • 4. hampers way the person thinks or acts…(people react negatively to you) • ***fuels more negative experiences •What are Depressive Attributional Styles? •(1) Internal •(2) Stable •(3) Global •all contribute to sense of hopelessness; attributions made internally, then assumed stable and global. Internal Attribution Style negative outcomes are one's own fault. Stable Attribution Style believing future negative outcomes will be one's own fault. Global Attributional Style believing negative events disrupt many life activities. EXAMPLE Explanatory style plays a major role in becoming depressed. Let’s say someone with depression messes up the icing on a cake they’re baking to take to a party A depressed person is likely to explain the problem: • something that was their fault (internal - its my fault the icing is messed up) • something that’s not going to change (stable – “I’m always going to be hopeless at everything and I’m never going to be good at cake icing”) • something that reflects a global characteristic of their personality (“I’m hopeless at everything” instead of just “I’m not good at icing cakes”) SOMATOFORM DISORDERS • characterized by history of recurrent and multiple physical symptoms for which are no apparent physical causes • Hypochondriasis: imagined illness • Conversion Disorder: anxiety produces a loss of physical function (w/no apparent cause) • BDD: body dysmorphic disorder Conversion Disorder PSYCHOLOGICAL DISORDERS Schizophrenia SCHIZOPHRENIA Nearly 1 in a 100 suffer from schizophrenia and world over 24 million people suffer from this disease Strikes young people as they mature into adults. Affects men and women equally, but men suffer from it more severely than women. Symptoms of Schizophrenia literal translation “split mind” a group of severe disorders characterized by: disorganized and delusional thinking (delusions) disturbed perceptions (hallucinations) inappropriate emotions and actions (flat effect) Delusions false beliefs, often of persecution or grandeur, that may accompany psychotic disorders Grandeur Persecution Sin or guilt Divine intervention Hallucinations sensory experiences without sensory stimulation • Inappropriate emotions • Flat effect: a zombie-like state of apparent apathy • Motor behavior inappropriate: senseless impulsive acts SUBTYPES OF SCHIZOPHRENIA •Schizophrenia is a cluster of disorders. •These subtypes share some features but there are other symptoms that differentiate these subtypes. TYPES OF SCHIZOPHRENIA Paranoid • Characterized by delusions of grandeur and persecution • Catatonic • Characterized by a stuporous state and/or periods of great excitement and agitation. • Disorganized • The most serious and characterized by inappropriate affect, silliness, laughter, grotesque mannerisms and bizarre behaviors. • Undifferentiated • The symptoms do not conform to a specific type • POSITIVE SYMPTOMS OF SCHIZOPHRENIA •Schizophrenics have inappropriate symptoms •hallucinations •disorganized thinking • delusions •not present in normal individuals NEGATIVE SYMPTOMS OF SCHIZOPHRENIA Schizophrenics also have absence of appropriate symptoms apathy expressionless faces rigid bodies (catatonic) present in normal individuals CHRONIC SCHIZOPHRENIA • When schizophrenia is slow to develop (chronic/process) recovery is doubtful. • Such schizophrenics usually displays negative symptoms. ACUTE SCHIZOPHRENIA • When schizophrenia rapidly develops (acute/reactive) recovery is better. • Such schizophrenics usually shows positive symptoms. ABNORMAL BRAIN CHANGES Schizophrenia patients may express changes in the brain like enlargement of fluid filled ventricles. Brain Abnormalities • Dopamine Overactivity: Researchers have found that schizophrenic patients express higher levels of dopamine receptors in the brain. • Use drugs to block dopamine DEVELOPMENTAL DISORDERS • Autism • Attention Deficit Hyperactivity Disorder • Conduct disorder • Tourette’s Syndrome HISTORY OF TREATMENT THERAPY Psychotherapy an emotionally charged, confiding interaction between a trained therapist and someone who suffers from psychological difficulties Eclectic Approach an approach to psychotherapy that uses techniques from various forms of therapy BIOLOGICAL MODEL • Also referred to as the medical model • There are chemical and/or anatomical disturbances in the brain • mental disorders as physical diseases • birth difficulties • Heritability • Influential because several disorders have been shown to have biological bases. PSYCHOLOGICAL MODEL • Disorders result from unresolved inner conflicts or early experiences • psychodynamic: unconscious conflicts • cognitive-behavioral: past learning, past history of rewards • humanistic: poor self-concept or unrealistic goals SOCIOCULTURAL MODEL • Emphasizes two factors: the behaviors and the social or cultural context the behavior is viewed • What is abnormal in one culture may NOT be abnormal in another CAUSES OF PSYCHOLOGICAL DISORDERS • Each model suggests a different approach to origin of the disorder and treatment. The major models include: • psychoanalytical • behavioral • humanistic • cognitive • biological • diathesis-stress model PSYCHODYNAMIC THERAPY • Try to understand childhood experiences • Probe for supposed repressed info • Help person gain insight to unconscious • “talk” therapy Psychoanalysis free associations, resistances dream analysis transferences the therapist’s interpretations of them – released previously repressed feelings, allowing patient to gain selfinsight PSYCHOANALYTIC METHODS OF THERAPY • 1. Free Association – patient reports anything that comes to his/her mind. • The psychoanalyst takes whatever you say and treats it like a window into your unconscious mind. 2. DREAM ANALYSIS • Dreams have two types of content: • Manifest content- actual events in dream. • Latent content – hidden message in dream. (latent = hidden) • Freud thought that each dream represents a form of wish fulfillment. The wish may be disguised, but it is always there. 3. Transference the patient’s transfer to the analyst of emotions linked with other relationships e.g. love or hatred for a parent toward the therapist Patient doesn’t respond leads to resistance 4. Resistance blocking from consciousness of anxiety-laden material Hint anxietyrepression use of psychoanalysis has rapidly decreased in recent years HUMANISTIC PERSPECTIVE • After years of psychoanalysts saying we are a bunch of id-driven animals • behaviorists studying rats in a cage • Humanists came along in the 60s. HUMANISTIC THERAPY • Emphasize people’s inherent potential for self-fulfillment • Help grow in self awareness & acceptance • Focus on present AND future • Conscious thoughts • Promote growth”clients” not patients HUMANISTIC THERAPY Client-Centered Therapy humanistic therapy developed by Carl Rogers therapist uses techniques such as active listening within a genuine, accepting, empathic environment to facilitate clients’ growth BEHAVIORAL THERAPY therapy that applies learning principles to the elimination of unwanted behaviors • Behaviorists believe that mental problems are caused by: • classical conditioning (for example, phobias), • operant conditioning (addictions, depression), and • observational learning (we watch our parents and friends suffer so we copy them). BEHAVIOR THERAPIES • B.F. Skinner and colleagues • Goal: unlearning maladaptive behavior and learning adaptive ones • Systematic Desensitization • Classical conditioning • Anxiety/Fear • exposure therapy • Aversion therapy • Alcoholism, sexual deviance, smoking Exposure Therapy treat anxieties by exposing people (in imagination or reality) to the things they fear and avoid BEHAVIOR THERAPY Systematic Desensitization type of counter-conditioning associates a pleasant, relaxed state with gradually increasing anxietytriggering stimuli commonly used to treat phobias Called “flooding” (rapid) BEHAVIOR THERAPY Systematic Desensitization (slow) CLASSICAL CONDITIONING • Flooding – (treats phobias) if you are afraid of snakes, therapist will throw you in a pit of snakes. Aversive Conditioning type of counter-conditioning that associates an unpleasant state with an unwanted behavior Drug nausea alcohol • Antabuse • Awful taste on nailsstop biting BEHAVIOR THERAPY Token Economy an operant conditioning procedure that rewards desired behavior patient exchanges a token of some sort, earned for exhibiting the desired behavior, for various privileges or treats Behavior modification COGNITIVE THERAPY • Cognitive therapy focuses on changing how the client/patient thinks. • It can be confrontational • The therapist focuses on changing/fixing the irrational thoughts of the patient COGNITIVE THERAPY • We are depressed because we are irrational. • Our expectations are too high and misplaced. • We want everyone to love us & accept us. • We want every thing to go our way. • We stay angry about stuff that happened a long time ago. Cognitive Therapy teaches people new, more adaptive ways of thinking and acting WE MUST CHANGE THE WAY WE THINK TO BE HAPPY AND SUCCESSFUL. COGNITIVE-BEHAVIORAL THERAPY • Aaron Beck • Cognitive therapy • Depression and negative thinking • Albert Ellis • Rational-emotive therapy • Goal: to change the way clients think • Detect and recognize negative thoughts RATIONAL EMOTIVE THERAPY: ELLIS • A-B-C theory of dysfunctional behavior • A – Activating event • B – Belief • C – Consequence (emotion) based on that belief. RATIONAL EMOTIVE THERAPY • Known as RET • Developed by Albert Ellis • Proposed that irrational thoughts lead to negative emotions • Control and change thoughtskey to better mental health • Find a positive in a negative situation • Confrontational “Dr. Phil” EXAMPLE OF RATIONAL THINKING • A= fail a midterm examination • B=It’s unfortunate that I failed-I did not study hard enough and I must make sure that I study harder for the final • C=no consequences (no emotional disturbance) EXAMPLE IRRATIONAL THINKING: LEADS TO EMOTIONAL DISTURBANCE • A= Fail exam • B= I’m stupid, I’ll never be able to pass this course and I will fail this course • C=depression Cognitive-Behavioral Therapy (CBT) a popular integrated therapy that combines cognitive therapy (changing self-defeating thinking) with behavior therapy (changing behavior) Aaron Beck GROUP AND FAMILY THERAPIES Family Therapy treats the family as a system THERAPIES INSPIRED BY POSITIVE PSYCHOLOGY • Martin Seligman • Uses theory & research to better understand the positive, adaptive, creative & fulfilling aspects of human existence • positive psychotherapy • can be an effective treatment for depression EVALUATING PSYCHOTHERAPIES To whom do people turn for help for psychological difficulties? Meta-analysis (What works!) procedure for statistically combining the results of many different research studies WHAT IS A PSYCHIATRIST? • Psychiatrists are MDs (medical doctors) with a specialty in treating mental disorders • usually with a biomedical therapy (medicine) • use if you have: • schizophrenia, • severe depression • suicidal thoughts • other severe mental problems that need medication. WHAT IS A CLINICAL PSYCHOLOGIST? • A clinical psychologist has a PhD in psychology (no medical school). • treat fairly serious mental illnesses with “talk” therapies. • Treat • personality disorder • anxiety disorders • addictions • using insight or “talk” therapy. Clinical or Psychiatric Social Worker A two-year Masters of Social Work graduate program plus postgraduate supervision prepares some social workers to offer psychotherapy mostly to people with everyday personal and family problems Looking for a Career in Psychology? Counseling psychologist Clinical psychologist Psychiatrist Psychoanalyst Clinical social worker Professional Title Counseling psychologist Specialty: Clinical psychologist Problems of normal living Psychiatrist Work setting: Psychoanalyst Schools, clinics, other institutions Clinical social worker Credentials: Master’s in counseling, PhD, EdD, or PsyD Professional Title Counseling psychologist Specialty: Clinical psychologist Those with severe disorders Psychiatrist Psychoanalyst Clinical social worker Work setting: Private practice, mental health agencies, hospitals Credentials: PhD or PsyD Professional Title Counseling psychologist Clinical psychologist Psychiatrist Psychoanalyst Clinical social worker Specialty: Severe mental disorders (often by means of drug therapies) Work setting: Private practice, clinics, hospitals Credentials: MD Professional Title Counseling psychologist Clinical psychologist Specialty: Psychiatrist Psychoanalyst Clinical social worker Freudian therapy Work setting: Private practice Credentials: MD Professional Title Counseling psychologist Clinical psychologist Psychiatrist Specialty: Social worker with specialty in dealing with mental disorders Psychoanalyst Work setting: Clinical social worker Often employed by government Credentials: MSW Module 52 The Biomedical Therapies HOW IS THE BIOMEDICAL APPROACH USED TO TREAT MENTAL DISORDERS? •Biomedical therapies seek to treat mental disorders by changing the brain’s chemistry with drugs •its circuitry with surgery, or its patterns of activity with pulses of electricity or powerful magnetic fields DRUG THERAPIES DRUG THERAPIES Psychopharmacology study of the effects of drugs on mind and behavior Lithium chemical that provides an effective drug therapy for the mood swings of bipolar (manic-depressive) disorders • Psychopharmacotherapy • Antianxiety (benzodiazepines) • Valium, Xanax, Buspar, librium • Antipsychotic - Thorazine, Mellaril, Haldol • Tardive dyskinesia • Antidepressant: depression • Tricyclics: increase inhibitory GABA • MAO inhibitors (MAOIs) - Nardil • Selective serotonin reuptake inhibitors (SSRIs) – Prozac, Paxil, Zoloft – side effects – • Risk of suicide • Mood stabilizers • Lithium, DRUG THERAPY • Antipsychotic drugs (neuroleptics) • alleviate the symptoms of severe disorders such as schizophrenia; Examples: Thorazine, Clozapine, Haldol • Neuroleptics block dopamine receptor sites • can produce sluggishness, tremors, and twitches similar to those of Parkinson’s disease (tardive dyskinesia) DRUG THERAPY • Antianxiety drugs • Anxiolytics (benzodiazepines) • Reduces anxiety • work by depressing central nervous system activity (inhibitory GABA) • Most common side effect - drowsiness • highly addictive • Stop use can result in severe withdrawal symptoms, including seizures, increased anxiety, and in rare cases, death Xanax, Paxil, Valium DRUG THERAPY • Antidepressants and mood stabilizers • Include Prozac, monoamine oxidase (MOA) inhibitors, and • lithium carbonate (effective against bipolar disorder) • Treat depression and bipolar disorder • Usually affect serotonin and/or norepinephrine ANTIDEPRESSANTS • Monoamine oxidase inhibitors (MAO) • Increase serotonin, norepinephrine • Tricyclics – safer ; inhibit reuptake serotonin • SSRIs: increase neurotransmitters • Prozac Side effect: tardive dyskinesia – facial tics, involuntary movements ELECTROCONVULSIVE THERAPY PSYCHOSURGERY • Surgery that removes or destroys brain tissue • Egas Moniz – the lobotomy • Cut nerves in frontal lobeemotion controlling center/emotional and violent patients • “McMurphy” BRAIN-STIMULATION THERAPIES • Electroconvulsive therapy is used for the treatment of severe depression • Repetitive Transcranial magnetic stimulation (rTMS), a possible alternative to ECT, can also be used for the treatment of depression, schizophrenia, and bipolar disorder ELECTROCONVULSIVE THERAPY