Psychopathology or Psychological Disorders

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Psychopathology or
Psychological Disorders
KING LEAR
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Prevalence
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Lifetime Rates by Gender
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Diagnosis A Necessary Step

• Diagnosis
• Process of identifying and grouping mental
  disorders with similar symptoms
• DSM-IV American Psychiatric Associations
  Diagnostic and Statistical Manual
  of Mental Disorders (4th Edition)

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Advances in diagnosis and therapy are success
stories for clinical psychology/ psychiatry
In 1955, 500,000
institutionalized for psychological
disorders Today 65,000 But mental hygiene
arrests continue to this day (suicide, squalor,
starving)
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Major Affective Disorders
The mind is its own place, and of itself Can
make a Heaven of Hell, a Hell of Heaven
- John Milton (Paradise Lost)
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Major Affective Disorders
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What is Bipolar disorder?
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Mood cycles
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Creativity Bipolar
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Creativity Mood Dysfunction
Iowa Writers Workshop, Andreasen, 1987
Other studies find 30x normal incidence rate in
writers, musicians
Why are they linked?
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Famous Bipolar Artists
Hans Christian Anderson Ludwig von Beethoven
Lord Byron Charles Dickens T. S. Eliot Ralph
Waldo Emerson William Faukner F. Scott
Fitzgerald Paul Gauguin Vincent van Gogh
Ernest Hemingway Michelangelo Sylvia Plath
Edgar Allan Poe Gordon Sumner (Sting) Peter
Tchaikovsky Leo Tolstoy Mark Twain Virginia
Woolf Tennessee Williams

• Creativity Connection
• Emotional reactive (unfiltered life)
• Disinhibited (loose associations)
• Absorption (focus)
• Intense creative episodes during hypomania

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Vicious Cycle of Depression
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Beck Depression Inventory (BDI)
Twenty-one dimensions of depression 1.
Sadness                              12. Social
withdrawal 2. Pessimism                          
13. Indecisiveness 3. Sense of failure            
       14 Change in body image 4.
Dissatisfaction                     15.
Retardation 5. Guilt                              
     16. Insomnia 6. Expectation of punishment   
17. Fatigability 7. Dislike of self               
        18. Loss of appetite 8. Self
Accusation                    19. Loss of
Weight 9. Suicidal ideation                   20.
Somatic preoccupation 10. Episodes of
crying              21. Low level of energy 11.
Agitation In past week including today 0 I do
not feel sad 1 I feel sad 2 I am sad all the
time and I cant snap out of it 3 I am so sad
that I cant stand it 0-63 max score (30
indicates severe depression)
Aaron Beck
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Treatment for Unipolar
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Antidepressants
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Suicide
30,000 Americans each year Nearly 2x the
homicide rate 8th leading cause of death,
3rd for teens 2 x above the world rate -
16.7/100K Japan (1997) - 11.9/100K USA
(1997) Females attempt 3x males, but males
succeed 4x 60 successes with firearms Since
1950, suicide rates in teens has tripled
Myth of Sisyphus (Camus) There is only one
really serious philosophical question, and that
is suicide
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Suicide in Depression Cycle
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Anxiety Disorders
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Phobia
Intense irrational fear of object or situation
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Obsessive-Compulsive Disorder (OCD)

• Obsessions repetitive thoughts
• - germs, terrible events, symmetry order
• Compulsions repetitive behaviors
• - grooming, rituals, checking locks, appliances

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Dissociative Identity Disorder

• Previously Multiple personality disorders (MPD)

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Schizophrenia
Split Mind Disorders involving gross
distortions of thoughts and perceptions and by
loss of contact with reality
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Scz the Disorder of Science and Math
Isaac Newton suffered psychotic break Albert
Einstein autistic traits, Scz son John Nash Jr
chronic schizophrenia Bertrand Russell James
Joyces daughter Syd Barrett (of Pink
Floyd) Socrates (perhaps, or temporal lobe
epilepsy)
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Types of Schizophrenia

• Paranoid Delusions or hallucinations often
  include extreme suspiciousness and hostility
• Disorganized Exhibit signs of illogical thinking
  and speech
• Catatonic Exhibit extremes in motor behavior
• Undifferentiated Do not clearly fit into a type

• Catatonia

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Positive Negative Symptoms

• Positive Sx cognitive, emotional, and behavioral
  excesses.
• hallucinations, delusions, thought disorders, and
  bizarre behaviors.
• Negative Sx cognitive, emotional, and behavioral
  deficits.
• apathy, flattened affect, social withdrawal,
  inattention, and slowed speech or no speech.

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Schizophrenia rates

• 1 across all cultures, despite few offspring
• Male females, or slightly more males
• More in jails than psychiatric hospitals
• 50 never accept that they are ill
• 90 go off meds once (relapse within 3y)
• Nearly 100 smoke (self-stimulation)
• Higher prevalence in lower socioeconomic class
• 25 full remission, 50 recurrent relapses
  (living independently on meds or less
  autonomously in group homes), 25 permanently
  hospitalized
• 40 attempt suicide, 10 succeed

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DSM-IV Criteria

• Delusions
• Hallucinations
• Speech changes
• Motor symptoms
• Mood symptoms
• Cognitive symptoms
• Must show 2 of following for 6 months

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Delusions incorrect conclusions about
perceptions

• Peculiar beliefs, culturally based aliens,
  secret lovers, paranoia, grandiosity, thought
  insertion or broadcast, erotomania
• Ideas of reference events
  has special personal meaning
• Magical thinking
  control events from afar

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DSM-IV Criteria

• Delusions
• Hallucinations
• Speech changes
• Motor symptoms
• Mood symptoms
• Cognitive symptoms
• Must show 2 of following for 6 months

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Hallucinations inaccurate perceptions

• Most auditory some visual, olfactory, tactile
• Commanding voice of authority God, historical
  figure, parent alive or dead
• Derisive, insulting
• Running commentary of life, feelings, thoughts

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DSM-IV Criteria

• Delusions
• Hallucinations
• Speech changes
• Motor symptoms
• Mood symptoms
• Cognitive symptoms
• Must show 2 of following for 6 months

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Speech changes

• Mute vs pressured (word salad)
• Insensitive to the informational needs of
  audience
• Overall, a poverty of speech

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DSM-IV Criteria

• Delusions
• Hallucinations
• Speech changes
• Motor symptoms
• Mood symptoms
• Cognitive symptoms
• Must show 2 of following for 6 months

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Motor symptoms

• Catatonia
• Peculiar (e.g., strip naked to greet)
• Bizarre gestures, grimaces
• Stereotypies (rocking, flapping)
• Violence to self, or family members

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DSM-IV Criteria

• Delusions
• Hallucinations
• Speech changes
• Motor symptoms
• Mood symptoms
• Cognitive symptoms
• Must show 2 of following for 6 months

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Mood symptoms

• Blunted, inappropriate, or exaggerated
• Flat affect, anhedonia, avolitional, vegetative
• Suicidal

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DSM-IV Criteria

• Delusions
• Hallucinations
• Speech changes
• Motor symptoms
• Mood symptoms
• Cognitive symptoms
• Must show 2 of following for 6 months

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Cognitive Symptoms

• Attention disorder
• Loose associations (knights move)
• Memory impairment
• Executive functioning serial, perseveration,
  monitoring

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Knights Move
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Impaired Theory of Mind

• Failure to monitor
• what different people can know
• ones own intentional actions
• informational needs of others
• one simply thought something
• mental and physical distinctions

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Course of Onset (Warning signs)

• lt7y Failure to develop dominant hand early (55
  autistics fail as well)
• 8-12 y interpersonal problems, poor emotional
  control, high IQ, sensitive
• 12-16y cognitive problems begin,
  underachievement, disorganized thoughts, poor
  emotional rapport, few friends
• 17-20y prodomal or precursory withdrawal,
  decreased grooming, altered school or work
  performance, delusions emerging, abuse
  hallucinogens like marijuana or LSD

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Genetic Component

• Risk of developing schizophrenia in ones
  lifetime increases as genetic relatedness with a
  diagnosed schizophrenic increases.
• Dopamine hypothesis