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Psychological Disorders

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Title: Psychological Disorders


1
  • Chapter 13
  • Psychological Disorders

2
Psychological Disorders
  • Psychological Disorder
  • a harmful dysfunction in which behavior is
    judged to be
  • atypical--not enough in itself
  • disturbing--varies with time and culture
  • maladaptive--harmful
  • unjustifiable--sometimes theres a good reason

3
Psychological Disorders
  • Medical Model
  • concept that diseases have physical causes
  • can be diagnosed, treated, and in most cases,
    cured
  • assumes that these mental illnesses can be
    diagnosed on the basis of their symptoms and
    cured through therapy, which may include
    treatment in a psychiatric hospital
  • Thomas Schaz

4
Psychological Disorders
  • Bio-Psycho-Social Perspective
  • assumes that biological, sociocultural, and
    psychological factors combine and interact to
    produce psychological disorders

5
Psychological Disorders
6
Classifying Psychological Disorders
  • DSM-IV
  • American Psychiatric Associations Diagnostic and
    Statistical Manual of Mental Disorders (Fourth
    Edition)
  • a widely used system for classifying
    psychological disorders
  • presently distributed as DSM-IV-TR (text revision)

7
Anxiety Disorders
  • Anxiety Disorders
  • distressing, persistent anxiety or maladaptive
    behaviors that reduce anxiety
  • Generalized Anxiety Disorder
  • person is tense, apprehensive, and in a state of
    autonomic nervous system arousal

8
Anxiety Disorders
  • Panic Disorder
  • marked by a minutes-long episode of intense dread
    in which a person experiences terror and
    accompanying chest pain, choking, or other
    frightening sensation

9
Anxiety Disorders
  • Phobia
  • persistent, irrational fear of a specific object
    or situation
  • Obsessive-Compulsive Disorder
  • unwanted repetitive thoughts (obsessions) and/or
    actions (compulsions)

10
Anxiety Disorders
  • Common and uncommon fears

11
Anxiety Disorders
12
Anxiety Disorders
  • PET Scan of brain of person with obsessive-
    compulsive disorder
  • High metabolic activity (red) in frontal lobe
    areas involved with directing attention

13
Dissociative Disorders
  • Dissociative Disorders
  • conscious awareness becomes separated
    (dissociated) from previous memories, thoughts,
    and feelings
  • Dissociative Identity Disorder
  • rare dissociative disorder in which a person
    exhibits two or more distinct and alternating
    personalities
  • formerly called multiple personality disorder

14
Personality Disorders
  • Personality Disorders
  • disorders characterized by inflexible and
    enduring behavior patterns that impair social
    functioning
  • usually without anxiety, depression, or delusions

15
Personality Disorders
  • Antisocial Personality Disorder
  • disorder in which the person (usually man)
    exhibits a lack of conscience for wrongdoing,
    even toward friends and family members
  • may be aggressive and ruthless or a clever con
    artist

16
Mood Disorders-Depression
  • Boys who were later convicted of a crime showed
    relatively low arousal

17
Personality Disorders
  • PET scans illustrate reduced activation in a
    murderers frontal cortex

18
Mood Disorders
  • Mood Disorders
  • characterized by emotional extremes
  • Major Depressive Disorder
  • a mood disorder in which a person, for no
    apparent reason, experiences two or more weeks of
    depressed moods, feelings of worthlessness, and
    diminished interest or pleasure in most activities

19
Mood Disorders
  • Manic Episode
  • a mood disorder marked by a hyperactive, wildly
    optimistic state
  • 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

20
Mood Disorders
  • Mood disorders are also called affective
    disorders.
  • Affect emotion
  • Two poles to mood
  • up or manic
  • down or depression
  • excess focus on one pole or the other is
    pathological
  • Manic-depression (bipolar)

21
Mood Disorders
  • Balance between frontal lobe and emotional system
  • Especially amygdala

22
Personality Disorders
  • PET scans illustrate reduced activation in a
    murderers frontal cortex

23
Mood Disorders
  • Richard Davidson
  • Our research

24
Mood Disorders
  • In depression balance goes out of adjustment
  • Also important to brain maturation and
    personality maturation

25
Mood Disorders
  • Survey in 1990s cause of depression
  • 71 due to emotional weakness
  • 65 caused by bad parenting
  • 45 victims fault
  • 43 incurable (???)
  • 35 consequence of sinful behavior
  • 10 biological basis, involves brain

26
Mood Disorders
  • Diagnosis
  • how do you distinguish between a temporary,
    rather normal mood and clinical depression which
    should be treated?
  • Diagnostic and Statistical Manual of Mental
    Disorders (DSM-IV)
  • International Classification of Diseases (ICD-10)
  • Difficulties in diagnosis for example
    comparison of schizophrenia diagnosis in US and UK

27
Mood Disorders
  • Affective disorders are SYNDROMES
  • a collection or cluster of symtoms
  • mood quality
  • duration, intensity, valence
  • vegetative features
  • sleep, appetite, weight, sex drive
  • cognitive features
  • attention span, frustration tolerance, memory,
    negative distortions
  • executive dysfunction, planning, rumination
  • impulse control
  • suicide and homicide
  • behavioral features
  • motivation, pleasure, interests, fatigability
  • physical features
  • headaches, stomach aches, muscle tension

28
Mood Disorders
  • DSM IV criteria for depression episode
  • depressed mood most days
  • diminished interest or pleasure most days
  • significant weight loss or gain

29
Mood Disorders
  • DSM IV criteria for depression episode (cont)
  • insomnia or hypersomnia most days
  • psychomotor agitation or retardation most days
    (external observation)
  • fatigue or loss of energy most days

30
Mood Disorders
  • DSM IV criteria for depression episode (cont)
  • feelings of worthlessness or excessive/inappropria
    te guilt
  • diminished ability to think or concentrate (about
    things other than difficulties)
  • recurrent thoughts of death (not fear of dying),
    suicidal ideation without plan, a plan or attempt

31
Mood Disorders
  • 5 present for 2 weeks (must include 1 or 2)
  • change from previous function
  • symptoms impair function (in social,
    occupational, etc.) or cause clinically
    significant distress
  • not result of substance
  • not bereavement

32
Mood Disorders
  • Suicide committed by up to 15 (1 mo)
  • Attempts 1/10 (1 year depressed)
  • success 1/100 (1 year depressed)
  • 1/7 with recurrent depression
  • 5 to 11 will be depressed at some point
  • Episodes can last years
  • Long lasting depression has high morbidity from
    suicide
  • 70 of suicides have depressive illness
  • 20 40 of patients consider or attempt suicide
    (nonfatal)
  • 16,000 suicides per year (30,000)
  • 15 of those hospitalized

33
Mood Disorders
  • Untreated, most episodes last 6 24 months
  • Three Rs
  • response to treatment
  • decrease of gt 50 on Hamilton Depression Rating
    Scale or other (Beck, SKID, MMPI)
  • remission
  • all symptoms go away
  • recovery
  • remission for gt 6 mos
  • Two Rs
  • relapse
  • worsening before remission or recovery
  • recurrence
  • worsening a few months after recovery

34
Mood Disorders
  • TREATMENT
  • Depression
  • 2/3 response rate to a given medication
  • 1/3 respond to placebo
  • 40 still ill after 1 year treatment, 40
    recovered, 20 dysthymic
  • THE GOOD NEWS
  • Up to 90 response if multiple medications and
    combinations are tried
  • up to 50 of responders remit w/in 6 mo
  • 2/3 w/in 2 yrs
  • Medication reduces incidence of relapses during
    1st year after response
  • ½ relapse if switched to placebo
  • 10 if not

35
Mood Disorders
  • DSM-IV criteria for manic episode
  • period of abnormally and persistently elevated,
    expansive, or irritable mood
  • at least 1 week in duration
  • three or more of the following
  • inflated self-esteem or grandiosity
  • decreased need for sleep
  • more talkative than usual pressure to keep
    talking
  • racing thoughts, flights of ideation
  • distractable
  • increased goal-seeking activity
  • risky pleasure seeking (spending, sexual,
    business, etc.)
  • impairs functioning
  • not from substance

36
Mood Disorders-Depression
37
Mood Disorders- Suicide
38
Mood Disorders-Bipolar
  • PET scans show that brain energy consumption
    rises and falls with emotional switches

39
Mood Disorders-Depression
  • Altering any one component of the
    chemistry-cognition-mood circuit can alter the
    others

40
Mood Disorders-Depression
  • The vicious cycle of depression can be broken at
    any point

41
Mood Disorders-Depression
  • The vicious cycle of depression can be broken at
    any point?
  • Actually, this may not be true. Rumination
    cognitive therapies have limited success
  • Stressful experiences may not be under control

42
Schizophrenia
  • Schizophrenia
  • literal translation split mind
  • Disconnection
  • Thomas Szasz
  • a group of severe disorders characterized by
  • disorganized and delusional thinking
  • disturbed perceptions
  • inappropriate emotions and actions

43
Schizophrenia
  • Schizophrenia
  • Is polar
  • Seems to involve either too much or too little
    dopamine
  • Gain hypothesis

44
Schizophrenia
  • Delusions
  • false beliefs, often of persecution or grandeur,
    that may accompany psychotic disorders
  • Hallucinations
  • sensory experiences without sensory stimulation

45
Schizophrenia
46
Schizophrenia
47
Schizophrenia
48
Schizophrenia
49
Rates of Psychological Disorders
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