© Kip Smith, 2003

Mental Disorders

© Kip Smith, 2003

Topics

Categories of mental disorders Neuroses Psychoses

Neuroses

Psychoses

Diagnosis using the DSM

© Kip Smith, 2003

Mental distress ≠ mental disorder

Just because you are bummed out doesn’t mean you are mentally ill

For example, sadness, pessimism and low self-esteem are all parts of normal mental life, as long as they

Do not persist Do not have a biological origin Are essentially voluntary

E.g., you know WHY you are temporarily bummed

© Kip Smith, 2003

Mental disorders

Neurosis Distressed but still rational and social

Psychosis Loss of contact with reality, irrational ideas &

distorted perception

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Criteria for considering behavior to be a Disorder

The behavior must be Unjustifiable & Maladaptive & Atypical & Disturbing ==

Distressing

Distressing behavior may be rational or not

If behavior is NOT in the person’s best interest, then the behavior suggests some form of psychosis

© Kip Smith, 2003

Rationality

Acting in a manner that you know is in your own best interest = will help you achieve your goal

Neurotics are rational but distressed

Psychotics are NOT rational

© Kip Smith, 2003

Examples of Neuroses

Anorexia - bulimia Anxiety

Obsessive - compulsive Post trauma stress Phobia

Mood disorders Depression Mania Bipolar syndrome

Personality disorders Anti-social Histrionia Narcissism

Sexual dysfunction Substance abuse

Sometimes it is hard to tell when a behavior

crosses the line

from neurosis to psychosis

© Kip Smith, 2003

Anorexia - bulimia

Anorexia nervosa is a life-threatening eating disorder defined by a refusal to maintain body weight within 15 % of an individual's minimal normal weight. Other essential features of this disorder include an intense fear of gaining weight, a distorted body image, and amenorrhea (absence of at least three consecutive menstrual cycles when otherwise expected to occur) in women. Sometimes people starve and binge-purge, depending on the extent of weight loss. This can be physically very dangerous. People who present an on-going preoccupation with food and weight even at lesser weight reductions would benefit from exploring their cognitive and relationship skills.

http://www.nami.org/helpline/anorexia.htm

© Kip Smith, 2003

If you know someone with anorexia - Force her to confront it

http://www.anred.com

http://www.altrue.net/site/anadweb/

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Anxiety (Neurosis)

Continually tense, apprehensive; persistent autonomic (sympathetic) arousal

Obsessive-compulsive Anxiety with unwanted

repetitive thoughts and/or actions

High need for perfection and order

Phobia Persistent irrational fear

Panic Post-traumatic stress

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Obsession

Recurrent and persistent thoughts, impulses, or images that are experienced, at some time during the disturbance, as intrusive and inappropriate and that cause 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 the thoughts, impulses, or images, or to neutralize them with some other thought or action

The person recognizes that the obsessional thoughts, impulses, or images are a product of his or her own mind (not imposed from without as in thought insertion)

© Kip Smith, 2003

Compulsion

Repetitive behaviors (e.g., hand washing, ordering, checking) or mental acts (e.g., praying, counting, repeating words silently) that the person feels driven to perform in response to an obsession, or according to rules that must be applied rigidly

The behaviors or mental acts are aimed at preventing or reducing distress or preventing some dreaded event or situation; however, these behaviors or mental acts either are not connected in a realistic way with what they are designed to neutralize or prevent or are clearly excessive

http://www.narsad.org/bd/ocp.html

© Kip Smith, 2003

Obsessive-Compulsive disorder

At some point during the course of the disorder, the person has recognized that the obsessions or compulsions are excessive or unreasonable.

Note: This does not apply to children.

The obsessions or compulsions cause marked distress, are time consuming (take more than one hour a day), or significantly interfere with the person's normal routine, occupational (or academic) functioning, or usual social activities or relationships.

Reprinted from the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. Copyright 1994 American Psychiatric Association.

© Kip Smith, 2003

Mood Disorders (Neurosis)

Depression, Feelings of:

worthlessness low self-esteem pessimism low motivation generalization of

negative attitudes psychomotor

dysfunction More women than men

(report) being depressed 2: 1

Mania Euphoria Inflated self-esteem Grandiosity Fragmented attention

Bipolar Mood swings between

the hopelessness of depression and the euphoria of mania

(manic depression)

© Kip Smith, 2003

Depression

http://www.narsad.org/bd/dep.html

Depression isn't just a brief blue mood or a passing sadness that lifts in a few hours or even a few days. People who have depression -- or, in more formal clinical terms, major depressive disorder -- experience at least five of the following symptoms, which must include the first or second, nearly every day, all day, for at least two weeks:

© Kip Smith, 2003

Symptoms of depression, 1

Persistent depressed mood, including feelings of sadness or emptiness

Loss of interest or pleasure in activities or hobbies that were once enjoyed, including sex

Feelings of hopelessness and pessimism

Feelings of guilt, worthlessness, and helplessness

Insomnia, early-morning awakening, or oversleeping

Loss of appetite accompanied by weight loss or overeating accompanied by weight gain

© Kip Smith, 2003

Symptoms of depression, 2

Decreased energy, fatigue, and feeling "slowed down"

Restlessness and irritability

Difficulty concentrating, remembering, and making decisions

Thoughts of suicide or death (not just fear of dying) or suicide attempts

Persistent physical symptoms, such as headaches, digestive disorders, or chronic pain, that do not respond to medical treatment and for which no physical cause can be found

© Kip Smith, 2003

Mania

A manic episode is characterized by a distinct period of a mood change that is either elevated (to the point of elation), expansive, or irritable.

During this phase, which may last from several days through several months, the patient's behavior causes difficulties in both professional and social activities.

http://www.narsad.org/bd/bip.html

© Kip Smith, 2003

Symptoms of mania

Decreased need for sleep

Increased pressure of speech

Distractibility

Irritability

Inflated self-esteem or grandiosity

Excessive involvement in activities that have a high risk for pain consequences that are not recognized

© Kip Smith, 2003

Bipolar syndrome

Behavior oscillates between depression and mania

Used to be called manic depression

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Bipolar manic episodes

Frequently, those experiencing a manic episode do not realize they are affected and will therefore resist any medical treatment attempt.

Close friends will recognize the mood and behavior patterns as being excessive, while the casual observer may not see anything disturbing.

The patient may become frankly psychotic with delusions and hallucinations.

© Kip Smith, 2003

Bipolar depressed episodes

A depressive phase usually lasts two weeks to many months, during which the time the patient will experience a lack of interest or pleasure in all activities.

Patients may describe themselves as feeling sad or blue, devoid of motivation, or worthless. These feelings and thoughts may or may not be stated openly in front of others.

© Kip Smith, 2003

Bipolar depressed episodes

The course of a depressive episode may vary from person to person. Symptoms may develop over a period of days or weeks, or they may occur suddenly, without warning. Sudden onset of this condition can be caused by external factors, including stress, death of a family member, or divorce. Duration of an episode will vary and depends on medical treatment employed.

http://www.narsad.org/bd/bip.htm

© Kip Smith, 2003

Personality Disorders (Neurosis)

Inflexible and enduring patterns of behavior that impair social functioning

Relatively untreatable Patients do not think

anything is wrong & resist treatment

Histrionic Display shallow,

attention-getting emotions, sexual aggression

Narcissistic Exaggerated self-image

(aided by fantasies) Anti-Social

Complete disregard for others’ rights

Lack of a conscience for wrong-doing

© Kip Smith, 2003

Psychosis Alzheimer’s

Schizophrenia

DissociationAmnesiaFugueIdentity disorder

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Poster Boy for Psychosis

Ted Kaczynski, ex-professor of math, lived alone in a shack, rarely bathed, sent bombs to strangers

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Schizophrenia

Schizophrenia is classified in people who exhibit the following traits:

Characteristic symptoms Social/occupational dysfunction Duration > 6 months No mood disorders (depression, mania, mixed) Not due to drug use Not due to developmental disorder (autism)

© Kip Smith, 2003

Symptoms of schizophrenia

Two (or more) of the following, each present for a significant portion of time during a 1-month period (or less if successfully treated):

1. delusions

2. hallucinations

3. disorganized speech (e.g., frequent derailment or incoherence)

4 grossly disorganized or catatonic behavior

5. negative symptoms, i.e., affective flattening, alogia, or avolition

© Kip Smith, 2003

Positive and negative symptoms

Positive symptoms Disorganized, delusional

thinking Distorted perception, Inappropriate emotions

and actions Bizarre behavior

± Paranoia Pervasive distrust and

suspicion of others ± Catatonia

Negative symptoms No interest in other

people or social relationships

Detached from social relationships

Emotionally cold with flat affect

Pervasive interpersonal deficits

Poverty of speech Apathetic attention

© Kip Smith, 2003

Social dysfunction

For a significant portion of time since the onset of the disturbance, one or more major areas of functioning such as work, interpersonal relations, or self-care are markedly below the level achieved prior to the onset (or when the onset is in childhood or adolescence, failure to achieve expected level of interpersonal, academic, or occupational achievement).

http://www.narsad.org/bd/sch.html

© Kip Smith, 2003

Psychopharmacology of Schizophrenia

Too much dopamine in the frontal lobe

The mind runs amok

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Dissociative Disorders(Psychoses)

A disruption in the usually integrated functions of consciousness, memory, identity or perception

Amnesia Fail to recall events

Fugue Fail to recall past & Run away & Assume new identity

Identity Disorder Multiple personalities Most rare, usually faked

© Kip Smith, 2003

Diagnosing neuroses and psychoses

© Kip Smith, 2003

Diagnostic and Statistical Manual of Mental Disorders

DSM 4th edition Provides a multidimensional approach to

diagnosing disorders diagnostic criteria prevalence data case illustrations

Uses decision trees to guide diagnoses

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The dimensions are NOT mutually exclusive

DSM’s 5 Dimensions of Disorder

1 Clinical symptoms 2 Personality disorders 3 General medical conditions 4 Psychosocial & environmental problems 5 Global assessment of functioning

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1 Clinical symptoms

Anxiety Depression Schizophrenia Substance abuse

Includes alcohol

Disorders Sleep Sexual Eating

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2 Personality Disorders

Obsessive-compulsive Dependent personality

Passively allows others to make decisions Antisocial personality

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3 General Medical Conditions

Any medical conditions relevant to understanding or treatment

Organic brain damage Diabetes HIV

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4 Psychosocial, Environmental Problems

Social support structure Death of a loved one Discrimination Economic or legal problems

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5 Global Assessment of Functioning

Current occupational functioning Highest level of functioning in the past

year

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Periods of mild mania and mild depression

Due to a medical condition

Due to drug, meds, or toxins

Periods of mania and at least one

period of depression

Periods of depression with psychosis

(delusions or hallucinations)when not depressed

IfNO

Mood disorder due to a med. cond.

Substance-induced mood disorder

Bipolar disorder, Type 1

Bipolar disorder, Type 2

Schizophrenia

Depression

Sample DSM Decision Tree for a Patient with Depressed Mood

If YES

© Kip Smith, 2003

Models of Psychological Disorders

Medical model Disorders are diseases

Disorders can be diagnosed on the basis of their symptoms

Disorders can be treated and, often, cured

Diathesis-Stress Model Biological predisposition

+ Stress -> disorder

“Humpty dumpty had a thin shell.

Didn’t break until he fell.”