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Transcript of Psychological Disorders Specific Disorders for our BIG “Landscape” Notes Created by Andy...
Psychological Disorders
Psychological Disorders
Specific Disorders for ourBIG “Landscape” Notes
Created by Andy FilipowiczOcean Lakes High School, 2008
Definitions of Mental Disorder
1- Mental disorders as a violation of cultural standards or atypical
2- Mental disorder as maladaptive or harmful behavior
3- Mental disorder as a disturbing emotional distress.
4- Mental disorder as unjustifiable
Psychological Disorders
According to the LawM’Naghten Rule
1) must not know what you are doing is wrong OR2) must not understand the nature of the act
Stats on “legal insanity”…Discuss: Are the mentally insane more dangerous?Several articles on “legal
insanity” and more
Discussion Day 59• Why do we diagnose people with
psychological disorders? What exactly is the purpose of this
anyway?• What might be some potential benefits? Potential negatives/side
effects of such a diagnostic system?
Let’s discuss a few ideas…
Diagnostic & Statistical Manual of Mental
Disorders• DSM-IV (1994) contains more
than 300 mental disorders. (DSM-V to be released in May 2012)
• Provides diagnostic categories• Does not provide information on
causes• Does not provide information on
treatment• It is organized in 5 axes
The Five Axes• I = Categories of Psychological
Disorders • II = Personality & Developmental
Disorders• III = Medical Conditions• IV = Rating of Recent Social &
Environmental Stress• V = Global Assessment of Functioning
(GAF) from 1-100 (1 = severe dysfunction)
Discussion• What are some remaining issues stemming
from this system of classification?
• Boundary btwn normal / abnormal• Cut-offs for number of symptoms seems
random and arbitrary• How are specific time periods for symptom
duration chosen?• Auxiliary axes (premorbid history, quality of
relationships, work and family functioning)
Understanding Psychological
DisordersThe Biomedical ModelPsychological disorders are
sicknesses and can be diagnosed, treated, and even cured.
The Bio-Psycho-Social ModelHow biological, psychological, and
social factors interact to produce specific psychological disorders.
Anxiety Disorders• 1- Panic Disorder• 2- Generalized Anxiety Disorder
(GAD)• 3- Posttraumatic Stress Disorder
(PTSD)• 4- Phobias (fears)• 5- Obsessive-Compulsive Disorder
(OCD)
1 – Panic Disorder• Symptoms
– “recurrent, unexpected”– acute episode of intense anxiety without any apparent
provocation• Can’t breathe, heart pounding ,sweat, shake, feel like you’re
losing your mind– Additional anxiety comes from anticipating future attacks
this is actually what the disorder is (panic attacks are actually separate from the disorder; can have 1 without the other! (Abnormal book Pg. 117 Gretchen Attacked by Panic)
• Cause – based on perspective– NOT caused by a stressful event– LIKELY original cause physiological event (out of breath) and
then an unrelated troublesome thought (death of mother)– Increase in frequency following 1st panic attack– Low levels of GABA = inc anxiety – Genes tendency to be tense/uptight– Smoking incs likelihood of developing anxiety disorders
Panic Attack
1 – Panic Disorder – Stats and Treatment
• With or without agoraphobia (5.3% have this by itself)?– Fear and avoidance of situations in which they would feel
unsafe in the event of a panic attack or symptoms– Abnormal book pg. 126 (Mrs. M – Self-Imprisoned)
• 3.5% some point in their lives• 2/3 women
– Men drink– Women develop this agoraphobia
• Onset mid-teens to 40– Puberty is best predictor
• Less pervasive in elderly• Benzodiazepines/SSRIs = Prozac, Paxil, Xanax
2 – Generalized Anxiety Disorder (GAD)
• (abnormal book pg. 121 – Irene)• A general feeling of impending doom• Continually tense / jittery (from constant high-levels
of anxiety)– Muscle fatigue, tension common
• Worried that bad, horrible things might happen• Autonomic System Arousal
– racing heart, clammy hands, stomach butterflies, sleeplessness, twitching eyelids, fidgeting
• Cause: no specific cause– Genes: tendency to be tense– Learning: important events in life are
uncontrollable/dangerous– Stress makes them apprehensive, vigilant
2 – GAD Stats• 5% at some point• 2/3 female• Gradual onset, though first appears following a major
life change beginning in early adulthood (leaving home, getting a new job, having a baby, etc.)
• Chronic• Very prevalent in elderly• Treatment: Hardest of the Anxiety Disorders to treat
– Valium, Librium– Cognitive Behavioral Therapy purposefully confront
anxiety-provoking images and thoughts…develop strategies for dealing with these
3 – Posttraumatic Stress Disorder (PTSD)
• SYMPTOMS: flashbacks, nightmares, intrusive thoughts, intense physiological reactivity
• CAUSES:• When people are in danger, they produce high levels of natural
opiates, which can temporarily mask pain. They also produce stress hormones.
• People with PTSD tend to continue producing these hormones.• Norepinephrine is higher than normal. It activates the
hippocampus, which is involved with memory and long term memory.
• At high levels, stress hormones can become toxic and can damage the brain.
• Triggered by a life threatening trauma– Men: War– Women: Rape
• 25% of those experiencing a life threatening event develop PTSD
3—PTSD – Stats / Treatment
• Group therapy helps us to mimic normal relationships again
• Behavioral therapy experience the conditioned stim/response as NOT always together or anxiety will always persists– Systematic Desensitization
4 – Phobias• Acrophobia: fear of heights• Brontophobia: fear of thunder• Astraphobia: fear of lightning• Claustrophobia: fear of closed places• Porphyrophobia: fear of the color purple• Mysophobia: fear of dirt and germs• Agoraphobia: fear of being away from a safe
place. • Triskaidekaphobia: fear of number 13• Phobophobia
4 – Phobias – 3 Classes
• Specific (over 700, but not in DSM)– Search for Phobias
• Social – avoidance of social situations – 13.3% of pop at some point (35mil)– 1.4F: 1M– Peak onset = 15yrs
• Agoraphobia• Cause:
– Inherited = falling, loud noises, social seen in infants 4 months old
– Behavioral = observation, vicarious (latent) experience
Moving Images: 24:
Intensive Exposure Therapy
5 – Obsessive-Compulsive Disorder
(OCD)• Obsessions = Recurrent, persistent,
unwished-for thoughts or images.– Example: repetitive thoughts about killing
a child or becoming contaminated by shaking hands.
• Compulsions = Repetitive, ritualized behaviors that the person feels must be carried out to avoid disaster.– Example: hand washing, counting, &
checking (door locked, curling iron off)
5 – OCD – Causes • Video Moving Images: 22 OCD or OCD VHS• 2.6% at some point• 55-60% female (in kids though, ratio is
reversed)• Onset around 20, doesn’t show up past 30
– Boys develop OCD earlier• Article Strep throat!• High activity in front lobe just above the eyes• Freud = Anal Retentive• NT = lack of serotonin• Link to Tourette syndrome and Dopamine• Organic = brain tumors, injuries, stress,
viruses• 1918 flu epidemic spiked encephalitis also
increased OCD cases• Brain = abnormally high levels of activity in
the caudate nucleus, part of the basal ganglia known to be involved in initiation of learned behavior
Somatoform Disorders
• Defined = psychological problem manifested in a physiological symptom (see overhead slides)
• A - Conversion Disorder• B - Hypochondriasis• C – Body Dysmorphic Disorder
Conversion Disorder• NOT FAKING IT• Paralysis of a limb (most common)• Total paralysis• Weakness • Insomnia• Blurred vision, deafness, other
sensory effects• Pain – back, abdominal• Peak onset = mid-late 30s • “Shell shock” during WWI/II
• The patient has one or more symptoms or deficits affecting the senses or voluntary movement that suggest a neurological or general medical disorder.
• The onset or worsening of the symptoms was preceded by conflicts or stressors in the patient's life.
• The symptom is not faked or produced intentionally. • The symptom cannot be fully explained as the result of a
general medical disorder, substance intake, or a behavior related to the patient's culture.
• The symptom is severe enough to interfere with the patient's schooling, employment, or social relationships, or is serious enough to require a medical evaluation.
• The symptom is not limited to pain or sexual dysfunction, does not occur only in the context of somatization disorder , and is not better accounted for by another mental disorder.
Hypochondriasis
Body Dysmorphic Disorder
• “distorted body image”– Size, shape, form– Perception of physical appearance
• 50% get plastic surgery• Equal gender ratios• Onset: late childhood, early
adolescence (avg age is 17)
Dissociative Disorders
• ?- Amnesia
• @- Fugue
• #- Dissociative Identity Disorder (Multiple Personality Disorder)
?- Dissociative Amnesia
• Unable to recall important personal information or past events (name, origin, relationships, job, etc.)– General amnesia is anything at all (procedural stuff
is fine though ride a bike, how to talk, etc.)– Selective amnesia is specific traumatic events (war)
• Cause (all Dissociative Disorders): attempt to escape from traumatic event (past or present)
• Abnormal book: 179: The Woman who Lost Her Memory
@- Fugue• Memory loss is accompanied by an
unexpected trip• Confusion about personal identity• 0.2% of pop• Therapy: Psychotherapy to deal
with original traumatic event• Prognosis: A few months• Abnormal book: 180: The
Misbehaving Sherif
#- Dissociative Identity Disorder(Multiple Personality Disorder)
• IT IS NOT SCHIZOPHRENIA; IT’S TOTALLY DIFFERENT!!!!!!!! THIS WAS AN AP ESSAY QUESTION!
• Loss of time• Onset = 2-12 yrs old• At least 2 personalities, 10 is avg• Personalities have different names, sexes,
ages, voices, facial expressions, handwriting, physical problems– Often at least 1 is quite violent, aggressive
(FIGHT CLUB!)
#- Dissociative Identity Disorder(Multiple Personality Disorder)
• Almost non-existent outside of North America– India, Japan entirely nonexistent
• Self-multilation• EXCELLENT MEMORY!!! (when not in the alter egos)• Some can function in a “normal” life• Cause: physical, sexual, psychological abuse (not all who
are abused will develop it, but it’s a good place to look for a cause if someone has it)
• Video: Brain 23 Multiple Personality • May involve role playing as normal subjects under
hypnosis will express 2nd personality if instructed to do so by the psychologist/hypnotist
• 85% are female (http://skepdic.com/mpd.html)
Mood Disorders• - Major Depression (think Unipolar)
• & Bipolar Disorder aka Manic Depression
MIND 32: Mood Disorders: Hereditary Factors
Symptoms of Depression
Psychological Symptoms• Feeling of despair, hopelessness,
worthlessness, intense sadness #1 symptom
• Exaggerating minor failings and ignoring positive events
• Interpreting losses as signs of personal failures and concluding that happiness is not possible.
Physiological Symptoms• Insomnia/Hypersomnia, lack of appetite
trouble/ overeating, trouble concentrating, early morning wakeups
• DEBILITATING can’t go to work/schoolVIDEO: Moving Images: 23: Depression
Pg. 195 (Katie)
Causes / Stats of Depression• 1 more thing about symptoms: to be clinical
depression, symptoms must persist for at least 2 weeks in the absence of a clear reason
• If only during winter months (no sunlight = more melatonin = sleepy), SAD = Seasonal Affective Disorder
• Neurotransmitters: lack of serotonin, norepinephrine
• Lower activity in left frontal lobe• Freud: “anger turned inward”• Onset: mean = 25-29, though age of onset is
going down [3 month olds (207)]• Average duration of 1st episode = 6-9 months• 70% are women• Dysthmyic Disorder = chronic, lasting at least
2 years, not episodes, its chronic! But less severe…(not debilitating) (Double Depression = Dysthymic Disorder with occasional bouts of depression
• + common than bipolar, - common than phobias
Moving Images 23: Mike Wallace
NT Causes of...MANIA
• Excessive production of 1 or 2 NTs:–1-Norepinephrine
–2-Serotonin
DEPRESSION• Low levels of 1 of 2 NTs:
• 1-Norepinephrine–2-Serotonin
Mind: 31: Mania & Depression
Mania• An abnormally high state of exhilaration• Extreme pleasure in every activity (cleaning,
shopping, etc.)• Flight of ideas – lots at once• Excessive energy• Irrational decisions• Feeling of excessive hopefulness• Speaking rapidly and dramatically• Excessive feeling of ambition / grandiosity• Inflated self esteem
Pg. 202 abnormal book – Billy
Stages of Mania• 1-HypomaniaPatients are energetic, extroverted,
and assertive• 2-ManiaLoss of judgment• 3-Delusion with Paranoid
ThemesSpeech is generally rapid and
hyperactive behavior may lead to violence.
Bipolar DisorderManic-Depressive
• When people alternate between episodes of depression and one or more episodes of mania.
• Occurs equally in both sexes.• Mean onset is between 18-22, though 1/3
of cases actually begin in adolescence• 50/50 M/F• Those who have rapid cycling may
experience more episodes of mania and depression that succeed each other without a period of remission.
• Less common than depression
Bipolar DisorderManic-Depressive
• Cyclothymic Disorder =
People Who Had Bipolar
• Abraham Lincoln Edgar Allan Poe• Van Gough Virginia Wolf• Vivian Lee Walt Whitman• Charles Dickens Ernest
Hemingway• Isaac Newton• Mark Twain
Mind 34: ECT for Depression
SAD• Seasonal Affective Disorder• 5% of North Americans
– 2% of Floridians– 10% of New Hampshirians
Schizophrenia• Overall must have at least 2 of the
following 5:– Delusions (+)– Hallucinations (+)– Disorganized Speech (mostly +)– Disorganized Behavior (inappropriate or
ineffective behavior) (mostly +)– Negative Symptoms
Schizophrenia – General Characteristics
• delusions = – Delusions of Persecution (CIA watching)
• “the doctor is out to get me” “that picture is meant for me” Beautiful Mind: codes in the newspaper
– Delusions of Grandeur (God-like, the president, Nobel Prize winner, savior of the world, etc.)
– Capgras Syndrome: someone you know replaced by a double
– Cotard’s Syndrome: thinks a part of the body has changed in some impossible way
Schizophrenia – General Characteristics
• Disturbed Perceptions = Hallucinations– Seeing / hearing / feeling usually
• Somatic hallucinations – “snakes are crawling around on me”
• Hearing voices (auditory hallucinations – most common)– interestingly, we find problems in Broca’s area (NOT
wernicke), so it’s not language composition, but as if one’s own produced language is repeated in the head as other people’s voices & the person can’t tell the diff
Schizophrenia – General Characteristics
• Disorganized speech & Thought– Lack insight, awareness of problem– Jump from topic to topic, talk illogically– Tangentiality, loose association– Overinclusion (word associations guide speech
“For dinner we had veal cutlets, tossed salad, and French fries, with lots of German, Polish, Spanish, and the United Snakes)
– Paralogic: “President Bush is a Texan. I come from Houston, TX. I’m the President.”
– Thought insertion or withdrawal
Schizophrenia – General Characteristics
• Disorganized behavior = Inappropriate or ineffective behaviors– Ex: wearing winter clothing on a hot
day– Ex: crying, laughing at inappropriate
times– Catatonia – no movement (- symptom)
OR rigid fixed behaviors– Flat Affect – no emotion (- symptom)
Negative Symptoms• Affective Flattening (2/3 have this) = don’t
show emotion in situations where you’d expect it
• Anhedonia = inability to feel pleasure; indifference
• Alogia = lack of meaningful speech• Avolition = lack of motivation• Cessation of personal hygiene
Other symptoms• Dissociative symptoms• Anosognosia• High rates of substance abuse
disorders• High risk of suicide• High rate of OCD / Panic Disorder• Downward drift
Onset of Schizophrenia• Chronic / Process schizophrenia
– Slow developing process– Recovery doubtful
• Acute / reactive schizophrenia– Previously well-adjusted person, in
reaction to life’s stresses, rapidly develops schizophrenia; recovery more likely
Onset statistics• Average age of onset = 15-30
– Men = usually younger than 25– Women = 26-45
• 1 % worldwide• EQUAL M/F
– Men likelihood of onset decreases with age (possible after even age 75)
– Women lower likelihood until age 36, then higher• Kids do show abnormal signs
– (more -, less +) • 78% have several episodes, not just 1• In US, Af-Am are diagnosed at a higher rate than
whites. WHY?• Could be a bias in who is tested
Neurotransmitters dopamine
• Over-activity of DA (impaired attention)• Over-sensitivity of DA receptors• Drugs mimicking DA (amphetamines,
cocaine intensify symptoms b/c they too increase DA levels)
• Anti-psychotic drugs reduce symptoms by blocking receptors for DA
Brain issues• Thalamus smaller than normal (could
explain hallucinations?)• Low activity in frontal lobes (judgment,
planning of behavior)– Major site of Dopamine activity
• Vesicles (fluid filled) larger (mostly only in men) = shrinkage of brain tissue
Prenatal factors• Pregnant women:• Exposed to the influenza virus
during 2nd trimester• Poor nutrition• Exposed to a variety of teratogens• Born in winter = greater chance
Genetic factors• 1% worldwide• 8% with sibling• 12% with 1 afflicted parent (30-40% when 2
parents have it)• 18% with Fraternal Twin• 50% with afflicted identical twin• Smooth-pursuit eye movement – watching a
pendulum swing isn’t as smooth for schizos• Most resistent to treatment of all psych
disorders (more resistant = more of a genetic factor)
Family factors• Schizophrenogenic Parenting Style –
mom who is cold, dominant, rejecting nature
• Double bind = punish for following directions OR confusing messages– Mother responds coolly to a child’s
embrace, then says “Don’t you love me anymore?” when the child withdraws…child is thinking what the heck??
• Families with high criticism, hostility, over emotional involvement
Potential causes• Big thing to know…• DIATHESIS-STRESS MODEL• 1) Genetic predisposition inherited (multiple genes)
– Tendency to exhibit certain traits / behaviors / neurological makeup, etc.
• ***Prenatal issues*** likely have some effect in here• 2) Stress (really like a trigger)
– People in war combat display temporary symptoms resembling schizophrenia
– Family factors• Schizophrenogenic mother• Double bind
Brain 27: Etiology
Sub-types of schizo• Paranoid• Disorganized• Catatonic• Undifferentiated
• See handout “Types of Schizophrenia”
Paranoid• Delusions of persecution or
grandeur. The individual may trust no one and may be anxious or angry about supposed tormenters
• Delusions, hallucinations stand out• Cognitive skills, affect in tact
Disorganized• disorganized behavior, disorganized
speech, and flat affect. Involving a disturbance in behavior, communication, and thought. There is a lacking of any consistent theme.
• Disruption of speech & behavior, inappropriate affect
• Self-absorbed• Delusions• More likely to be chronic
Catatonic• Odd mannerisms with bodies,
faces• Echolalia – mimic words of others• Echopraxia – mimic movement of
others
• Undifferentiated = everything else
Residual• Have had 1 episode but now no
longer have any major symptoms
Journal: Day 63• If you had to pick just 1, which of the
personality disorders best describes you? Give several general & specific reasons why you chose this answer.
• DO NOT REVEAL TO ANYONE!
Personality Disorders
• 20% of pop has at least 1• 50% of those treated for a psychiatric
disorder also have a personality disorder
• 10 PDs…2 ways to learn them…choose what works best for you
• DAN HAS BOPS• Or…• The 3 Cluster Format
NEW STUFF...Look at to Update these!
Clusters• Cluster A = odd, eccentric
– paranoid, schizoid, schizotypal• Cluster B = dramatic, emotional,
erratic– antisocial, borderline, histrionic,
narcissistic• Cluster C = anxious, fearful
– avoidant, dependent, OCPD
Paranoid• Suspicious, mistrustful, interprets
others motives as malevolent, don’t pay attention to facts that contradict thoughts
• Argumentative, complains, hostile• Refusal to go with the group in debates,
doesn’t like authority figures, fears passive surrender
• Cause: compensating for feelings of weakness– Think self is weak, so sees threats
everywhere– (2:1 M:F)
• Jake: Abnormal 411
Cluster A = odd, eccentricparanoid, schizoid, schizotypal
Schizoid• loner-type, lacks feelings for others, indifferent to
others, detached• Dopamine (too much) issues• 3.5:1 M:F• Mr. Z: 413
Schizotypal• socially isolated, behaves in unusual
ways, suspicious, odd beliefs, detached, eccentric (half-crazy), magical thinking (but not illogical)
• Ideas of reference = insignificant events relate directly to them
• Dresses strangely/unusually • A Phenotype of the schizophrenic
Genotype• About even M/F• Mr. S: 415
Cluster A = odd, eccentric
paranoid, schizoid, schizotypal
Antisocial• THE MOST COMMON (4:1 M:F; 3%,
1%)• Sociopath, violates rights of others
without remorse, immoralistic, just don’t care about hurting others
• frequently breaks the law • irritable, aggressive, manipulative• charming con-artist• little desire for the truth• If <18, called “Conduct Disorder”• Cause:
– low cortical arousal or insufficient development – cortex is childlike, impulsive
– Higher threshold for experiencing fear
• Cluster B = dramatic, emotional, erratic
– antisocial, borderline, histrionic, narcissistic
Mind 35: Mind of the Psychopath
Ryan: 417
Borderline• Instability in interpersonal relationships, mood, & self-image
• “Girl Interrupted”• Theory = abandonment depression (live
in fear of being abandoned), so they distract themselves with alternative destructing actions
• 25% have major depression; 10% have bipolar disorder (cause = link to mood disorders)
• Uses splitting see others as either awesome or horrible (idealization vs. devaluation)
• 2% of pop; (2:1 F:M)• 10% of people with this commit suicide
by age 30• Claire: 426
• Cluster B = dramatic, emotional, erratic
– antisocial, borderline, histrionic, narcissistic
Histrionic• Overly dramatic (almost acting) Excessive emotionality,
need for attention• shallow, vain, self-centered, uncomfortable if not in the
limelight, seductive in appearance/behavior• seeks reassurance/approval constantly• Angry when others don’t attend to them or praise them• Impulsive, great difficulty delaying gratification• Tend to say everything they think• Focused on repression – while seductive, represses
sex/aggression (disgusted if blatant sex appears in a movie)
• 5:1 F/M• Pat: 429
• Cluster B = dramatic, emotional, erratic
– antisocial, borderline, histrionic, narcissistic
Narcissistic• Exaggerated self-regard, self-
importance, needs constant admiration
• Lack sensitivity/compassion for others
• Grandiosity• Actually has low self-esteem,
insecure, inferiority complex underlies all thoughts
• Can be good empathizers (reciprocity desires)
• 2:1 M:F
• Cluster B = dramatic, emotional, erratic
– antisocial, borderline, histrionic, narcissistic
Avoidant• Sensitive to rejection, so avoid relationships
• Equal M/F• Jane: 432
• Cluster C = anxious, fearful
Dependent• Excessive need to be taken care
of, • Unable to make choices and
decisions independently• Overly cooperative, submissive• Yield and placate, not assertive,
clingy• Fear of abandonment• 2.5:1 F:M• Karen: 434
avoidant, dependent, OCPD
Obsessive-Compulsive
• Opposite of histrionic• highly focused thinking• attention to details• Cause: fears a lack of control
b/c something bad could happen
• Inflexible• About even M/F• Daniel: 435
• Cluster C = anxious, fearful
avoidant, dependent, OCPD
Reactive Attachment Disorder
• http://www.youtube.com/watch?v=DcAuYRp2dJs