Psychological Disorders

Definition, diagnosis and treatment

What constitutes a disorder?

• Behavior is ___________

• Behavior is ___________

• Behavior is ___________

Understanding psychological disorders through the ages

• Ancient Greece: imbalance of the “four humours”

• Dark ages-Middle ages: devil or witchcraft

• 18th century: medical (biological) model of disease

• 20th century: biopsychosocial model of psychological disorders

Classification of disorders

• DSM-IV-TR - diagnostic manuals used by clinicians– Symptoms– Labels– Prognoses– Sample cases– Statistics

Anxiety disorders

• Characterized by feelings of excessive apprehension and anxiety– Generalized anxiety disorder– Phobic disorders– Panic disorder– Obsessive-compulsive disorder– Post-traumatic stress disorder

Generalized Anxiety disorder

• Symptoms-

-

-

• Prevalence

• Treatment

Phobic disorders

• Persistent and irrational fears– Social phobias

– Specific phobias• Acrophobia, claustrophobia, hemophobia,

pyrophobia, triskadekaphobia, ophidiophobia, astraphobia, nyctophobia, aichmophobia, coulrophobia, trichophobia…

Treatment for phobias

• Exposure– Systematic Desensitization– Flooding– Imaginal vs. In Vivo

• Classical Conditioning Rationale• Anxiety hierarchy

– Subjective Units of Distress (SUDS)

• Response prevention– Safety Cues

Panic disorder

• Panic attacks– Symptoms

– Not:

– May result in agoraphobia

Treatment for Panic Disorder

• Exposure is still used, but this time the cue for the fear is _________________. – Hypervigilance

• Exposure Techniques:– – –

• Breathing Retraining and Muscle Relaxation

Obsessive-Compulsive disorder

• Persistent obsessions and compulsions– Obsession =

– Compulsion =

Treating OCD

• Exposure with Ritual Prevention– Operational conditioning of fear through avoidance– Self Monitoring– Block compulsion responses to anxiety

• Cognitive Restructuring– Catastrophic Thinking

• Psychopharmacology– Clomipramine (anafranil). Fluoxetine (prozac),

Fluvoxamine (luvox)

Post-Traumatic Stress disorder

• Result of severe trauma and emotional distress.– Symptoms

– Lasting 4+ weeks

• Relies on (lack of) emotional resilience

Treating PTSD

• Prolonged Exposure– Expose to memories and cues related to

trauma– Imaginal: recite memories in first person

repeatedly until SUDS go down.– In vivo: spend time in similar environments

that create anxiety related to the trauma

Treatment for anxiety disorders

• Biological– Antianxiety drugs– Antidepressant drugs– D-Cycloserine

• Cognitive– Cognitive-behavior therapy

• Behavioral– Exposure therapy– Systematic desensitization

Mood disorders

• Disorders characterized by emotional extremes– Major depressive disorder– Bipolar disorder

Major Depressive disorder

• Overwhelming sadness, hopelessness and loss of interest– Symptoms

• Emotional• Cognitive• Motivational• Somatic

– Symptoms last 2+ weeks– Prevalence

Treating Depression

• Albert Ellis – Cognitive Therapy– Confronting Irrational Thinking

• Beck – Cognitive Behavioral Therapy– Socratic Dialogue– Thought Records

• Event – Feelings – Cognitions – Other interpretations– Cognitive Restructuring– Collaborative Empiricism

• Behavioral Homework Assignments• Scheduling Activities (Mastery, Pleasure, Tests)

• Jacobson – Behavioral Activation– Increase opportunities for reinforcement

Bipolar disorder

• Characterized by wide swings between two emotional extremes– Mania

– Depression

• Cyclic switching between moods• Treatment – Lithium and behavioral

therapies

Treatment for mood disorders

• Biological– Antidepressants (depression)– Mood stabilizers (bipolar)– Electroconvulsive therapy (depression)– Deep-brain stimulation (depression)– Transcranial magnetic stimulation

(depression)

• Psychotherapy– Cognitive-behavioral therapy– Psychodynamic/Interpersonal therapy

Personality disorders

• Maladaptive behaviors which impair social functioning– Antisocial personality disorder– Borderline personality disorder

Antisocial personality disorder

• Marked by a lack of conscience and malicious behavior patterns– Symptoms

– Prevalence• Low in ______________ population,

high in _______________ populations

Antisocial personality disorder

• Associated with reduced cortical volume and activation of the frontal cortex

• Also associated with low levels of stress hormones and arousal

Borderline personality disorder

• Unstable personality, mood, identity and behavior– Symptoms

• Emotional instability• Impulsivity• Unstable identity• Fear of abandonment• Paranoid ideation

– Prevalence• 3:1 Females:Males

Treating BPD

• Linehan - Dialectical Behavior Therapy– Individual Therapy

• Acceptance-Change dialectic

– Group Skills Training• Emotion Regulation• Distress Tolerance• Interpersonal Effectiveness• Mindfulness

– Therapist Consult Team– 24 Hour Phone Consultation

Schizophrenia

• Split from reality– Disorganization of thought, perceptions,

emotions and behaviors– Prevalence

Schizophrenia

• Symptoms– Positive

• Thought disorder• Hallucinations• Delusions

– Negative• Flat affect• Lack of motivation• Decline in communication and interaction

Schizophrenia

• Dopamine hypothesis - excess of DA causes positive symptoms

• Prenatal factors– Virus– Stress

• Environmental or developmental factor influences onset

Treatment for Schizophrenia

• Biological– Antipsychotic drugs

• Reduce dopamine• Long-term consequences

• Behavioral– Operant conditioning

• Token economy