Download Analyzing Psychological Disorders 1 Running Head: ANALYZING

Analyzing Psychological Disorders 1
Running Head: ANALYZING PSYCHOLOGICAL DISORDERS
Analyzing Psychological Disorders
Analyzing Psychological Disorders 2
Analyzing Psychological Disorders
Introduction
The biological approach to psychology dominates treatments in the field of
Biopsychology.
Psychological diseases and disorders are diagnosed from the
physiological point of view. This paper will include an analysis of the psychological
disorder called Schizophrenia. I will consider the brain areas affecting and affected by
the disorder, the possible causal factors, the characteristic symptoms, the neural basis
and the accepted drug treatments. I will also review the Generalized Anxiety Disorder
and the eating disorder, Anorexia Nervosa. These last two disorders will be considered
in relation to nature/nurture and theories of etiology.
Accepted drug therapies and
alternative treatments for these disorders will also be discussed.
Part A: Schizophrenia
This condition is one of the most complicated disorders that humans exhibit. Its
name comes from the symptoms which indicate that there is a “splitting of psychic
functions (Pinel, 2007, p.481)”. Symptoms of schizophrenia include, in varying severity
and combinations, hallucinations, grossly disorganized or catatonic behavior patterns
and negative symptoms, delusions and disorganized or incoherent speech (American
Analyzing Psychological Disorders 3
Psychiatric Association, 2000). Due to the severity of these symptoms, sufferers are
usually socially and occupationally dysfunctional. Diagnosis is based on the persistent
combination of function impairment and symptoms for a period of 6 months (American
Psychiatric Association, 2000).
Causal Theories and Neural Basis
A number of theories have been put forth regarding causal factors in
schizophrenic development.
There is a strong body of evidence that indicates the
disorder may have genetic links, especially to first degree relatives who have been
diagnosed as schizophrenic (Pinel, 2007).
This genetic component seems to be
combined with early trauma and stress that can trigger development of the disorder.
Neurodevelopment impairment early in life due to infection, autoimmune reactions and
toxin exposure may also contribute to later development of this disorder (Pinel, 2007).
Other theories hold that individuals who suffer from schizophrenia have
increased levels of the brain chemical dopamine. This theory was developed during
Parkinson’s disease research when the drug chlorpromazine was shown to be a
receptor blocker (Pinel, 2007).
The dopamine theory was advanced when the D2
receptors were found to be reactive to phenothiazines and butyrophenones.
Phenothiazines bind to both D1 and D2 receptors.
receptors.
Butyrophenones bind to D2
It was revealed that hyperactivity at the D2 receptor site and not all
dopamine receptor sites was evident in schizophrenia (Pinel, 2007).
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Additional research has recently shown that Schizophrenia may be connected to
other brain factors. Atypical neuroleptic drugs which do not act as D2 blockers may
have effects when given for prolonged periods of two weeks or more. These drugs
include clozapine which shows a negligible effect on the D2 receptors but exhibits an
increased effect on other brain receptors (D1, D4 and multiple serotonin receptors)
(Pinel, 2007).
The prolonged administration is required in spite of the fact that
neuroleptic drug therapy effectively blocks D2 receptors within just a few hours of
administration. This suggests that D receptors are not a key factor in this disorders’
etiology (Pinel, 2007).
These neuroleptic therapies do not provide relief for all
individuals who are diagnosed as schizophrenic. The neuroleptic drugs have proven to
be most effective in treating incoherence, hallucinations and delusions. They are less
effective in alleviating negative symptoms that are related to affect, cognitive deficits
and speech dysfunction. Thus, the D2 theory of hyperactivity at the receptor site is not
strongly supported by this conflicting treatment success (Pinel, 2007).
Brain imaging studies contribute information to the etiology of schizophrenia.
Brain abnormalities in the small cerebral cortex and enlarged cerebral ventricles are
seen in these patients (Pinel, 2007). These studies give further credence to the theory
that neural development issues contribute to the development of this disorder. There is
also abnormal brain laterality that cannot be explained by the dopamine theory (Pinel,
2007).
Appropriate Drug Therapies
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Group, family and psychotherapy are used to increase the success of
schizophrenic treatments. However, these therapies must be used in conjunction with
other effective drug therapies to be of use in treating the complex of symptoms
are experienced in this disorder (Grohol, 2008).
that
Combinations of antipsychotic,
antidepressant and anti anxiety medications may be used to address the entire range of
symptoms in a patient (Grohol, 2008).
Patients are very likely to discontinue their
medications due to side effects and/or ineffectiveness, so they must be monitored to
determine that the therapy is appropriate for that patient (Grohol, 2008).
Appropriate patient education must also be used to reduce the possible side
effects and so that the proper dosage and length of treatment course are followed.
Patient education also must include coping strategies that are appropriate for the side
effects of any treatment.
Treatment plans must be carefully designed to take into
account each patient’s current illness, target symptoms, age, medical history,
compliance abilities and interaction cautions for other drugs that they may be taking
(Bailey, 1998). The patient’s progress must be monitored throughout the course of
treatment to ensure responsiveness to treatment, dosage adjustments, patient
compliance and tolerance to any side effects (Bailey, 1998).
Schizophrenic individuals have shown the best responses to Clozapine as a
pharmaceutical treatment option, more so than to newer antipsychotic medications
(Grohol, 2008). Most antipsychotic medications have a high risk of serious side effects.
Therefore, patients must be monitored throughout the course of their treatment when
Analyzing Psychological Disorders 6
these medications are used. Side effects of antipsychotic medications include central
nervous dysfunction, sedation, visual disturbances, gastrointestinal complaints, skin
discoloration, photosensitivity, reduced ability to sweat and possible allergic reactions.
These side effects vary in their severity and duration (Bailey, 1998).
Part B: Case Studies on Anorexia Nervosa and Generalized Anxiety Disorder
I received two case studies for biopsychological analysis.
I was asked to
examine the case study disorders with consideration of the nature-nurture debate and to
evaluate the advantages of any drug therapies for each of these cases. Case A is a
young woman who has been diagnosed with Anorexia Nervosa. Case B is an individual
who suffers from anxiety (Axia College, n.d.).
Case A: Anorexia Nervosa (Restricting Type)
Case A’s patient is named Beth. She became obsessed in her teen years by fear
of weight gain. This happened even though she was, at the time, of normal weight for
her age and height. Her response to this fear was to diet. She lost half her body weight
without gaining any benefit to her self-image. Her current weight is “dangerously thin”,
yet she continues to lose weight.
Her weight is so low that she experiences
amenorrhea (Axia College, n.d.). I would make the diagnosis for Beth of Anorexia
Nervosa (Restricting Type) (American Psychiatric Association, 2000).
Her disorder became out of control during her early dieting. The unreasonable
fear of the weight was the initial motivation for the dieting, but she did not respond to
Analyzing Psychological Disorders 7
weight loss by beginning to eat normally once she had lost weight.
Studies have found that adolescent females begin to diet as a direct response to
social cues that dictate physical attractiveness and acceptable weight limits that are
unreasonable and untenable.
They often develop this disorder if their personality
exhibits highly controlled, rigid or obsessive behaviors (Pinel, Assanand, & Lehman,
2000). Anorexia Nervosa may develop in due to negative incentive values becoming
ascribed to food.
This is another element that provides insight to this disorders’
development.
There is much confusion about the etiology of this disorder. The role of negative
or positive incentives surrounding food has not been made clear for these individuals.
Anorexics are generally obsessed with food, spending inordinate amounts of time in
food preparation or thinking and talking about food (Pinel, Assanand, & Lehman, 2000).
This would seem to indicate that food has some positive incentive value for the
anorexic. But this behavior does not necessarily indicate positive incentive since the
anorexic does not usually eat these foods, or binges and purges. They relate food
intake directly with weight gain, not with health and sustenance. Therefore, the food is
not seen in a positive incentive light. Food intake is not related to positive incentive
value in the anorexic person so they restrict their food intake (Pinel, 2007).
This particular eating disorder is devastating to both the sufferer and to their
families. The patient is literally starving themselves to death. This condition is very
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resistant to any treatment modality (Pinel, Assanand, & Lehman, 2000).
Causal factors can vary greatly in this disorder from one individual to another.
Clues to the etiology of anorexic patients may lie in an examination of their naturenurture history. Beth’s genetic makeup may leave her at risk for this particular disease.
There are a number of such factors that are common in anorexics. Nurture can also be
a contributing factor.
Family environment and social environment both can play
significant roles in the development of this disease. Psychotherapy would be indicated
to determine if pharmacological treatments would be indicated in this case.
In general, it has been found that pharmacological methods show little or no
effectiveness for anorexia treatment.
included tricyclic antidepressants.
(Barbarich-Marstellar, 2007).
Those methods examined for this use have
These inhibit norepinephrine and 5-HT uptake
Disappointing results have come from prescription of
selective serotonin reuptake inhibitors in acute phase treatment of this disease and also
are not found to be effective in relapse prevention (Barbarich-Marstellar, 2007). Classic
antipsychotics are known to result in weight gain as a side effect so anorexic patients
typically will refuse treatment with this class of drugs (Barbarich-Marstellar, 2007).
Case B: Anxiety (Generalized Anxiety Disorder)
This case is of a man named Tom. He is professionally successful and has three
children and a wife (Axia College, n.d.).
On external examination, his life seems
remarkably stable and fulfilling. However, Tom presents with the signs and symptoms
Analyzing Psychological Disorders 9
of Generalized Anxiety Disorder. He meets all the criteria of the American Psychiatric
Association’s for this diagnosis, since he exhibits excessive worry about his health,
finances, and job responsibilities that are not in keeping with the reality of his situation.
He has presented with these symptoms having been chronic for over 6 months
(American Psychiatric Association, 2000). His anxiety has begun to interfere with his
performance at work and his personal life. The physical symptoms of Generalized
Anxiety Disorder have manifested for him as muscle tension, headaches, hot flashes,
nausea, and fatigue. His sleep is regularly disturbed and he is irritable and has difficulty
concentrating (Axia College, n.d.). I would make the complete diagnosis of Generalized
Anxiety Disorder.
This disorder character is expressed in an overall anxiety which occurs in the
absence of obvious causal factors (Pinel, 2007). The genetic component of this disorder
is significant. There are theories about this disorder that indicate that it is experiential
rather than due to faulty neural functioning (Pinel, 2007). Nurture seems to be a very
salient factor in the development of this disorder.
It is remarkable in discussing this disorder that fear and anxiety are found in
studies to be guided by different brain mechanisms (“Fear and anxiety: A simultaneous
concept analysis,” 1999). Fear is an emotion directly regulated and connected to the
amygdale.
Anxiety is connected to the hippocampus (“Fear and anxiety: A
simultaneous concept analysis,” 1999).
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Benzodiazepines and serotonin agonists are most often prescribed as treatments
for these types of anxiety disorders. The intent of this treatment is the reduction of the
symptoms of anxiety (Pinel, 2007). Benzodiazepines are used widely in psychological
treatment plans, but they have high risk of addiction. Side effects also include tremors,
sedation, motor activity disruption and nausea.
The effects of withdrawal can be
extreme (Pinel, 2007). This class of drugs is more beneficial for patients who have one
of the other anxiety disorder diagnoses.
My recommendation for Tom would be a course of serotonin agonist. Buspirone
may be useful for this treatment as it can reduce his anxiety without giving him side
effects that are associated with the benzodiazepines. Serotonin agonists side effects
include headache, dizziness, nausea and possible sleep disturbances. These effects
do tend to diminish with continued use (Pinel, 2007). With counseling, he may manage
the initial side effects if they are not too severe. The benefits outweigh the long term
effects of the disorder itself (Pinel, 2007).
Conclusion
Each psychiatric disorder and disease is characterized by its own set of unique
symptoms.
They range in severity from mild to extreme. Causes and contributing
factors of these disorders and diseases include genetics, neurodevelopment issues,
brain damage and experience in various combinations. Generalized Anxiety Disorder
and Anorexia Nervosa are quite common and both are difficult to understand. The
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biological factors that can contribute to the onset, development and course of
psychological illness must be taken into account. Neural functioning and the role of
brain structures in behavior and thought processing can shed further light on an
individual’s disease process and prognosis. There are common threads in psychiatric
disorders in that they all cause the sufferer a great deal of personal distress.
Treatments vary widely in their success.
With additional research and study into the
causes and treatment modalities, it may be possible for many people who suffer from
these disorders to enjoy brighter futures.
Analyzing Psychological Disorders 12
References
American Psychiatric Association, (2000). Diagnostic and statistical manual of mental
disorders
(4th ed.). Washington, DC: Jaypee Brothers Medical Publishers Ltd.
Axia College. (n.d.). Appendix A: Case studies. Retrieved December 6, 2008, from Axia
College, Week Nine, PSY240 - The Brain, the Body, and the Mind.
Bailey, L. (1998). Schizophrenia and anti-psychotics. Available from University of Illinois
College of Pharmacy.
Barbarich-Marstellar, N.C. (2007). Neurochemistry and pharmacological treatments:
Where is
the field of anorexia nervosa heading?. Central Nervous System Agents in
Medicinal
Chemistry, 7, 35-43. Retrieved December 9, 2008, from EBSCOhost database.
Fear and anxiety: A simultaneous concept analysis (1999). Nursing Diagnosis, 10(3),
103-112.
Retrieved December 8, 2008, from CINAHL Plus database.
Grohol, J.M. (2008). Schizophrenia treatment. Psych Central. Retrieved December 9,
2008, from http://psychcentral.com/disorders/sx31t.htm
Pinel, J.P. (2007). Basics of biopsychology. Boston: Pearson Education.
Pinel, J., Assanand, S., & Lehman, D. (2000). Hunger, eating, and ill health. American
Psychologist, 55(10), 1105-1116. Retrieved December 10, 2008, from
ESBCOhost
database.