Psychological Disorders and Therapies Chapter 15 and 16

1
Psychological Disorders and TherapiesChapter 15
and 16

• To study the abnormal is the best way of
  understanding the normal.
• William James (1842-1910)

2
Rates of Psychological Disorders

• There are 450 million people suffering from
  psychological disorders (WHO, 2004).
• Depression and schizophrenia exist in all
  cultures of the world.
• Two Major Classifications
• Neurotic Distressing but one can still function
  in society and act rationally
• Psychotic Person loses contact with reality,
  experiences distorted perceptions

http//www.learner.org/resources/series60.html?pop
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3
Common Culture Bound Syndromes
Syndrome Region/Pop Affected Description
Koro Southeast Asia and Africa Episode of sudden and intense anxiety that the penis (or in women, the vulva and nipples) will recede into the body and possibly cause death.
Amok Malaysia Dissociative episode characterized by a period of withdrawal and brooding followed by an outburst of violent, aggressive or homicidal behavior often a response to a perceived slight
2-D Love Japan Men develop what appear to be amorous relationships with animated female characters they may carry around pillows or other tangible reminders of these characters wherever they go
Windigo Native Americans Morbid state of anxiety with fears of becoming a cannibal
Susto Mexico, Central America, and South America Illness attributed to a frightening event that causes the soul to leave the body and results in unhappiness and sickness. Ritual healings are focused on calling the soul back to the body and cleansing the person to restore bodily and spiritual balance
Taijin Kyofu Sho Japan Intense fear that ones body, its parts or its functions, displease, embarrass, or are offensive to other people in appearance, odor, facial expressions, or movements
4
Defining Psychological Disorders

• Mental health workers view psychological
  disorders as persistently harmful thoughts,
  feelings, and actions. Behavior is judged to be
• Atypical statistically infrequent uncommon
• Disturbing socially disagreeable behaviors
  (varies with time and culture)
• Maladaptive cause social or physical harm
• a. To self - Inability to reach goals, to adapt
  to the demands of life
• b. To society interferes, disrupts social group
  functioning
• Personal Distress behavior causes a person
  discomfort, anxiety, depression.
• Unjustifiable no good reason for behavior

5
DSM IV Multiaxial Classification (pg. 623-626
in CP )
Is a Clinical Syndrome (cognitive, anxiety, mood
disorders 16 syndromes) present?
Axis I
Is a Personality Disorder or Mental Retardation
present?
Axis II
Is a General Medical Condition (diabetes,
hypertension or arthritis etc) also present?
Axis III
Are Psychosocial or Environmental Problems
(school or housing issues) also present?
Axis IV
What is the Global Assessment of the persons
functioning?
Axis V

• The most recent edition, DSM-IV-TR (Text
  Revision, 2000), describes 400 psychological
  disorders compared to 60 in the 1950s. DSM-V is
  supposed to come out in May 2013

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Strengths/Weaknesses of DSM
Strengths Weaknesses
1. Describe (400) disorders Disorders outlined by DSM-IV are reliable. Therefore, diagnoses by different professionals are similar. Determines how prevalent the disorder is Labels may be helpful for healthcare professionals when communicating with one another and establishing therapy. Correct labeling of a disorder may help people identify the source of their unhappiness and lead to a proper treatment Does not explain CAUSES just describes disorder and lists prevalence Labels may stigmatize individuals and increase the risk of creating self-fulfilling prophecies. Rosenhan Study normal people misdiagnosed in mental hospital (http//www.psychblog.co.uk/video-being-sane-in-insane-places-163.html) May foster over-diagnosis and confuse serious mental disorders with normal problems in living Diagnoses can be misused for social and political purposes Insanity (legal status indicating that a person cannot be held responsible for his or her actions because of mental illness unable to distinguish right from wrong) labels raise moral and ethical questions about how society should treat people who have disorders and have committed crimes.

7
History of Mental Disorders Early Theories

• Afflicted people were possessed by evil spirits.
• Music or singing was often used to chase away
  spirits.
• In some cases trephening was used cutting a
  hole in the head of the afflicted to let out the
  evil spirit.
• Another theory was to make the body extremely
  uncomfortable.

8
Trephening
9
History of Mental Disorders Hospitalization

• In the 1800s, disturbed people were no longer
  thought of as madmen, but as mentally ill.
• They were first put in hospitals however, they
  were nothing more than barbaric prisons.
• The patients were chained and locked away and
  some hospitals even charged admission for the
  public to see the crazies, just like a zoo.
• Philippe Panel - French doctor who was the first
  to take the chains off and declare that these
  people are sick and a cure must be found!!!
  Insisted that madness was not due to demonic
  possession, but an ailment of the mind

10
Current Perspectives Medical Model

• When physicians discovered that syphilis led to
  mental disorders, they started using medical
  models to review the physical causes of these
  disorders. Psychological disorders are sicknesses
  and can be diagnosed, treated and cured.

1. Etiology Cause and development of the disorder.
2. Diagnosis Identifying (symptoms) and
   distinguishing one disease from another.
3. Treatment Treating a disorder in a psychiatric
   hospital.
4. Prognosis Forecast about the disorder.

11
Current Perspectives Biopsychosocial Perspective

• Assumes that biological, socio-cultural, and
  psychological factors combine and interact to
  produce psychological disorders
• (Mental illnesses are socially defined - major
  disorders, like depression and schizophrenia
  appear to be universal, however other disorders
  appear to be tied to specific cultures)

Used to be called Diathesis-Stress Model
diathesis meaning predisposition and stress
meaning environment.
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Models of Abnormality and Therapy Biological
Perspective
Physiological factors (brain activity, genes,
hormones, NTs, nervous) determine behavior and
mental processes

• Causes of Mental Disorders
• Physical diseases that can be treated medically
• Brain abnormalities
• Chemical imbalances
• Birth difficulties
• Heritability

• Treatment of Mental Disorders
• Drug Therapy
• Electroconvulsive Therapy (ECT) effective for
  certain kinds of severe, otherwise-untreatable
  depression.
• Psychosurgery/neurosurgery surgery to destroy
  selected areas of the brain thought to be
  responsible for emotional disorders. Prefrontal
  lobotomy.

13
Brain Abnormalities

• A PET scan of the brain of a person with
  Obsessive-Compulsive Disorder (OCD). High
  metabolic activity (red) in the frontal lobe
  areas are involved with directing attention.

Generalized anxiety, panic attacks, and even OCD
are linked with brain circuits like the anterior
cingulate cortex.
PET scans of 41 murderers revealed reduced
activity in the frontal lobes. In a follow-up
study repeat offenders had 11 less frontal lobe
activity compared to individuals without
antisocial personality disorder
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Brain Abnormalities
Schizophrenia patients may exhibit morphological
changes in the brain like enlargement of
fluid-filled ventricles.
Dopamine Overactivity Researchers found that
schizophrenic patients express higher levels of
dopamine D4 receptors in the brain (neurons using
dopamine fire too often).
15
Drug Therapy

• Anti-anxiety drugs Xanax , Valium, Klonopin,
  Ativan depress the central nervous system and
  reduce anxiety and tension by elevating the
  levels of the (GABA) neurotransmitter.

Atypical antipsychotic drugs Clozapine
(Clozaril) blocks receptors for dopamine and
serotonin to remove the negative symptoms
(apathy, jumbled thoughts, concentration
difficulties, and difficulties in interacting
with others) of schizophrenia but does not
restore normal thought patterns.
Classical antipsychotics Chlorpromazine
(Thorazine) removes a number of positive symptoms
associated with schizophrenia such as agitation,
delusions, and hallucinations.
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Drug Therapy
Anti-depressants Monoamine Oxidase (MAO)
inhibitors elevate levels of norepinephrine and
serotonin by blocking or inhibiting the enzyme
that deactivates these NT. Serotonin-norepineph
rine inhibitors (SNRIs) also elevate levels of
norepinephrine and serotonin by blocking the
reuptake of these NT.
Pre-synaptic Neuron
Serotonin
Norepinephrine
Post-synaptic Neuron
Anti-depressants Selective serotonin reuptake
inhibitors (SSRIs) (Prozac, Zoloft, and Paxil)
elevate levels of serotonin by preventing its
reuptake
Lithium Carbonate, a common salt, has been used
to stabilize manic episodes in bipolar disorders
reducing levels of norepinephrine and glutuamate
17
Brain Stimulation

• Electroconvulsive Therapy (ECT)
• ECT is used for severely depressed patients who
  do not respond to drugs. The patient is
  anesthetized and given a muscle relaxant.
  Patients usually get a 100 volt shock that
  relieves them of depression.

Transcranial Magnetic Stimulation (TMS) In TMS, a
pulsating magnetic coil is placed over prefrontal
regions of the brain to treat depression with
minimal side effects.
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Models of Abnormality and Therapy
Psychodynamic Perspective
Unconscious desires, needs, memories, and
conflicts determine behavior and mental
processes. Struggle to fulfill instinctive
desires and wishes despite societys rules

• Causes of Mental Disorders
• Repressed unconscious conflicts and drives
• Early childhood trauma

• Treatment for Mental Disorders
• Free association patient reports all feelings,
  thoughts, memories, and images that come to mind
  in order to bring repressed feelings into
  conscious awareness where the patient can deal
  with them
• Dream analysis
• When energy devoted to id-ego-superego conflicts
  is released, the patients anxiety lessens.

19
Psychoanalysis

• Dissatisfied with hypnosis, Freud developed the
  method of free association to unravel the
  unconscious mind and its conflicts.

Eventually the patient opens up and reveals his
or her innermost private thoughts, developing
positive or negative feelings (transference)
towards the therapist.
During free association, the patient lies on a
couch and speaks about whatever comes to his or
her mind. Often, the patient will edit his
thoughts, resisting his or her feelings to
express emotions. Such resistance becomes
important in the analysis of conflict-driven
anxiety.
Interpersonal psychotherapy, a variation of
psychodynamic therapy, is effective in treating
depression. It focuses on symptom relief here and
now, not an overall personality change.
20
Models of Abnormality and Therapy Cognitive
Perspective
The way we process, interpret, and store
information determines behavior and mental
processes. Emphasize cognitions (mental
processes such as learning, memory, perception,
thinking, and decision making)

• Causes of Mental Disorders
• Mental disorders are a result of learned
  maladaptive thought patterns or irrational
  thoughts (a misinterpretation of what is
  happening and is not supported by the available
  evidence)

• Treatment for Mental Disorders
• Rational Emotive Behavior Therapy (Albert Ellis)
  therapist challenges illogical beliefs directly
  with rational arguments aim is to identify
  self-defeating thought patterns and replace them
  with more constructive thoughts
• Cognitive Therapy (Aaron Beck) cognitive
  restructuring in which a client sees that his/her
  depression is due in part to erroneous and
  illogical thought patterns. Therapist helps
  point out those thoughts that precede anxiety and
  depression and then works with the client to test
  the logic of these thoughts.

21
Models of Abnormality and Therapy Humanistic
Perspective
Ones inborn tendency to grow toward his/her
unique potential determines behavior and mental
processes. Emphasize free will, self-concept,
and self-actualization

• Causes of Mental Disorders
• Distorted sense of self
• Growth-thwarting environment (real and ideal self
  are incongruent did not receive unconditional
  positive regard or empathy)

• Treatment
• Do not delve into the past help people to feel
  better about themselves here and now boost
  self-fulfillment by helping people grow in
  self-awareness and self-acceptance.
• Client-centered therapy (Carl Rogers) - therapist
  offers unconditional positive regard
  (non-judgemental) to build self-esteem therapist
  must be warm, genuine, and empathic so client can
  adopt these views and become self-accepting
• Active listening - echoes, restates, and
  clarifies the patients thinking, acknowledging
  expressed feelings

22
Models of Abnormality and Therapy Behaviorist
Perspective
Learning through rewards and punishments in our
external environment (classical conditioning,
operant conditioning, observational learning)
determines behavior and mental processes.

• Causes of Mental Disorders
• Learned maladaptive patterns of behavior cause
  mental disorders

• Treatment
• Counterconditioning
• Flooding or exposure treatments therapist
  accompanies client into the feared situation
• Systematic desensitization a step by step
  process of desensitizing a client to a feared
  object or experience based on counterconditioning
  
• Aversive conditioning substitutes punishment
  for the reinforcement that has perpetuated a bad
  habit
• Behavior Modification
• Skills training practice in specific acts
  needed to achieve goals
• Token economy - in institutional settings
  therapists may create a token economy in which
  patients exchange a token of some sort, earned
  for exhibiting the desired behavior, for various
  privileges or treats

23
Anxiety Disorders

• Anxiety (a sense of apprehension that shares many
  of the same symptoms as fear but builds more
  slowly and lingers longer) that persists to the
  point that it interferes with ones life.
• The CNSs physiological and emotional response to
  a vague sense of threat or danger.
• http//www.youtube.com/watch?v_Cr7IomSy8s

• Generalized anxiety disorders
• Phobias
• Copycat Agoraphobia http//www.youtube.com/watch?v
  u0dpgmwETcgplaynext1listPLD14A589E28BB9502
• Obsessive-compulsive disorders
• As Good as it Gets http//www.youtube.com/watch?v
  44DCWslbsNM
• Aviator http//www.youtube.com/watch?v7FapiKgs4y8
  featurerelated
• Greys Anatomy http//www.youtube.com/watch?vETFQ
  9fyRP0sfeaturerelated
• Exposure Therapy Aims to Curb OCD
  http//www.youtube.com/watch?vB-qtnCiX5b4
• Deep Brain Stimulation for OCD http//abcnews.go.c
  om/video/playerIndex?id3379057
• Panic disorders
• Posttraumatic Stress Disorder

24
Generalized Anxiety Disorder

• Symptoms
• Feeling unexplainably tense and uneasy
• Anxiety and worry are associated with at least 3
  of these symptoms restlessness, easily
  fatigued, difficulty concentrating, irritability,
  muscle tension, sleep problems
• Difficulty controlling the worry, which may
  develop into panic attacks
• Inability to identify or avoid the cause of
  certain feelings.
• Occurs more days than not for six months

I wish I could tell you whats the matter.
Sometimes I feel like something terrible has just
happened when actually nothing has happened at
all. Other times, Im expecting the sky to fall
down any minute. Most of the time I cant point
my finger at something specific. The fact is
that I am tense and jumpy almost all the time.
Sometimes my heart beats so fast, Im sure its a
heart attack. Little things can set it off. The
other day I thought a supermarket clerk had
overcharged me a few cents on an item. She
showed me that I was wrong, but that didnt end
it. I worried the rest of the day . I kept
going over the incident in my mind, feeling
terribly embarrassed at having raised the
possibility that the clerk had committed an
error. The tension was so great, I wasnt sure
Id be able to go to work in the afternoon.
25
Panic Disorder

• Symptoms
• Recurrent, unexpected attacks of acute anxiety ,
  peaking within 10 minutes.
• Such panic may occur in a familiar situation,
  such as a crowded elevator.
• May include feelings of terror, chest pains,
  nausea, choking, or other frightening sensations.
• Can cause secondary disorders, such as
  agoraphobia (phobia of open places)

It happened without any warning, a sudden wave of
terror. My heart was pounding like mad, I
couldnt catch my breath, and the ground
underfoot seemed unstable. I was sure it was a
heart attack. It was the worst experience of my
life.
26
Phobia Disorder

• Symptoms
• Marked by a persistent and irrational fear of an
  object or situation that disrupts behavior and is
  often accompanied by extreme anxiety symptoms
• Participate in elaborate ways to avoid the object
  or situation just thinking about the thing you
  fear causes anxiety

I cant tell you why Im afraid of rats. They
fill me with terror. Even if I just see the word
rat my heart starts pounding. I worry about
rats in restaurants I go to, in my kitchen
cupboard, and anywhere I hear noise that sounds
like a small animal scratching or running.
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Types of Phobic Disorder

• Specific Phobia
• Most common phobias specific animals or
  insects, heights, enclosed spaces, thunderstorms,
  and blood
• Social Phobia
• Severe, persistent and unreasonable fears of
  social or performance situations in which
  embarrassment may occur
• Agoraphobia
• Intense fear of being alone in public places from
  which escape would be difficult or help is not
  readily available

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Obsessive-Compulsive Disorder

• Persistence of unwanted thoughts, wishes, images,
  ideas, doubts (obsessions) and urges to engage in
  senseless rituals (compulsions) that cause
  distress.

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Obsessive-Compulsive Disorder

• 20 of those with OCD have only obsessions or
  only compulsions all others experiences both
• Obsession A young woman is continuously
  terrified by the thought that cars might careen
  onto the sidewalk and run over her. Compulsion
  She always walks as far from the street pavement
  as possible and wars red clothes so that she will
  be immediately visible to an out-of-control car
• Obsession A college student has the urge to
  shout obscenities while sitting through lectures
  in classes. Compulsion Carefully monitoring
  his watch, he bites his tongue every sixty
  seconds in order to ward off the inclination to
  shout
• Obsession A young boy worries incessantly that
  something terrible might happen to his mother
  while sleeping at night. Compulsion ON his way
  up to bed each night, he climbs the stairs
  according to a fixed sequence of three steps up,
  followed by two steps down in order to ward off
  danger.

I felt the need to clean my room spent four to
five hour at it At the time I loved it but then
didn't want to do it any more, but could not stop
The clothes hung two fingers apart I touched
my bedroom wall before leaving the house I had
constant anxiety I thought I might be nuts.
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Common Examples of OCD
Common Obsessions Common Compulsions
Contamination fears of germs, dirt, etc. Washing
Imagining having harmed self or others Repeating
Imagining losing control of aggressive urges Checking
Intrusive sexual thoughts or urges Touching
Excessive religious or moral doubt Counting
Forbidden thoughts Ordering/arranging
A need to have things "just so" Hoarding or saving
A need to tell, ask, confess Praying
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Acute Stress Disorder

• Characteristics of traumatic event
• Threatened death or serious injury
• Persons response involved intense fear,
  helplessness, or horror
• During/after event person has 3 or more
  dissociative symptoms
• Feel numb, detached, or lack of emotional
  responsiveness
• Less aware of surroundings
• Derealization - an alteration in the perception
  or experience of the external world so that it
  seems strange or unreal
• Depersonalization - subjective experience of
  unreality in one's sense of self
• Dissociative amnesia
• Traumatic event is persistently re-experienced
• Avoidance of stimuli that reminds one of the
  traumatic event
• Disturbance lasts for a minimum of 2 days and a
  maximum of 4 weeks of the traumatic event

32
Post-Traumatic Stress Disorder

• Repeated, anxious reliving of a horrifying event
  over an extended period of time.

1. Haunting memories

2. Nightmares
3. Social withdrawal
4. Jumpy anxiety
5. Sleep problems
Bettmann/ Corbis
http//www.mtv.com/videos/true-life-i-have-post-tr
aumatic-stress-disorder/1601333/playlist.jhtml
33
Etiology of Anxiety Disorders

• Biological
• Genetic runs in families
• Inherit overly responsive autonomic nervous
  system
• Overactivity of norepinephrine, (noradrenaline),
  specifically connected to the onset of panic
  attacks
• Lack of serotonin function, especially in OCD and
  social phobias.
• Deficiency in GABA
• Too much glutamate in OCD patients, which causes
  the alarm center in the brain to keep going off
• Overactive amygdala or an underactive prefrontal
  cortex, which creates an inability to turn off
  the initial stress response by the amygdala
• Evolutionary
• Biological preparedness to acquire some fears
  much more easily than others

• Behavioral
• Through observational learning, children adopt
  behaviors of anxiety disorders displayed by their
  parents.
• As demonstrated in the Little Albert experiment,
  fear can be classically conditioned and then
  maintained through operant conditioning
• Cognitive
• A lack of perceived control (social-cognitive)
• Inaccurate or irrational interpretation of an
  event/stimulus.
• Psychodynamic
• Ego defense mechanisms are inadequate.
• Sociocultural Perspective
• Pressures, such as poverty or race, that cause
  anxiety.

34
Treatment of Anxiety Disorders

• Behavioral
• Counterconditioning
• Exposure Therapy
• Systematic desensitization
• (Video 13)
• Flooding
• Aversion conditioning
• Biological
• Antianxiety drugs (Valium, Xanax) reduce the
  symptoms of anxiety, nervousness, and sleeping
  problems by increasing the level of GABA, which
  inhibits nerve impulses in the brain.

35
Generalized Anxiety Disorder results from

• Psychodynamic Perspective
• Ego defense mechanisms are inadequate
• Severe punishment for expressing id impulses,
  which causes high levels of anxiety
• Cognitive Perspective
• Unrealistic goals or unreasonable beliefs about
  the world and ourselves that foster worry and
  fears.
• Inaccurate or irrational interpretation of an
  event/stimulus Tendency to overgeneralize and
  magnify the significance of an event.
• Lack of perceived control.
• Sociocultural Perspective
• Pressures, such as poverty or race, that cause
  anxiety.
• Behavioral Perspective
• Observational learning parents model the
  characteristics of anxiety disorders for their
  children trouble leaving the house or being
  overly concerned about certain events.
• Humanistic Perspective
• People not looking at themselves honestly and
  acceptingly

36
Generalized Anxiety Disorder results from

• Biological Perspective
• Certain people inherit autonomic nervous system
  traits that make them vulnerable or predisposed
  to anxiety (such as, overly responsive or
  reactive, strong alarm tendencies,). Minor
  events trigger anxiety.
• Heritability of anxiety is 30 to 40
• Anxiety disorders run in families
• Breakdown in the neural circuitry that signals
  the brain to stop responding. May be a result of
  an overactive amygdala or an underactive
  prefrontal cortex, which creates an inability to
  turn off the initial stress response by the
  amygdala
• Anti-anxiety drugs Xanax , Valium, Klonopin,
  Ativan depress the central nervous system and
  reduce anxiety and tension by elevating the
  levels of the neurotransmitter GABA. Deficiency
  in GABA, inhibitory disorder, which could account
  for racing thoughts.

37
Panic Disorder results from

• Biological Perspective
• Heightened startle response hypersensitivity
  to neurochemicals that alert sympathetic nervous
  system.
• Overactive norepinephrine (NT linked with
  arousal)
• Cognitive Perspective
• Full panic reactions are experienced only be
  people who misinterpret bodily events

38
Phobia Disorder results from

• Behavioral Perspective
• Learning theorists suggest that fear conditioning
  leads to anxiety. This anxiety then becomes
  associated with other objects or events (stimulus
  generalization) and is reinforced.
• Fear is initially learned through classical
  conditioning
• Claustrophobia
• NS (closet) ? no response
• UCS (lack of oxygen) ? UCR (gasping for air)
• UCS (lack of oxygen) NS (closet) ? UCR (gasping
  for air)
• CS (closet) ? CR (gasping for air)
• Generalization closet to enclosed spaces
• Fear is then maintained through avoidance
  (operant conditioning) because the individual
  avoids the thing he/she is afraid of, there are
  no opportunities for reality testing and new
  learning.
• Investigators believe that fear responses are
  inculcated through observational learning. Young
  monkeys develop fear when they watch other
  monkeys who are afraid of snakes.

39
Phobia Disorder results from

• Since phobias most likely develop as a result of
  fear conditioning, therapists use learning
  principles to eliminate unwanted behaviors.
• Counterconditioning is a classical conditioning
  procedure that conditions new responses to
  stimuli that trigger unwanted behaviors.
• Exposure Therapy - expose (in real or virtual
  environments) patients to things they fear and
  avoid. Through repeated exposures, anxiety
  lessens because the brain habituates to the
  fear.
• Systematic Desensitization - A type of exposure
  therapy that associates a pleasant, relaxed state
  with gradually increasing anxiety-triggering
  stimuli
• Flooding immediate, direct and constant
  exposure to feared object, no chance of escape
• Aversive Conditioning - associates an unpleasant
  state with an unwanted behavior.
• I

40
(No Transcript)
41
Phobia Disorder results from

• Operant conditioning procedures enable therapists
  to use behavior modification, in which desired
  behaviors are rewarded and undesired behaviors
  are either unrewarded or punished.
• Token Economy - In institutional settings
  therapists may create a token economy in which
  patients exchange a token of some sort, earned
  for exhibiting the desired behavior, for various
  privileges or treats.
• I

42
Phobia Disorder results from

• Biological Perspective
• Natural Selection has led our ancestors to learn
  to fear snakes, spiders, and other animals.
  Therefore, fear preserves the species. Role of
  biological preparedness people are biologically
  prepared by their evolutionary history to acquire
  some fears much more easily than others
• Twin studies suggest that our genes may be partly
  responsible for developing fears and anxiety.
  Twins are more likely to share phobias
• Giving anti-depressants, such as SSRIs

43
Obsessive Compulsive Disorder results from

• Psychodynamic Perspective
• Id battles with ego on conscious level
• Id impulses obsessive thoughts
• Ego defenses counter-thoughts or compulsive
  actions
• Behavioral Perspective
• Compulsions are learned by chance
• Exposure and response prevention (ERP), in which
  OCD sufferers dont try to avoid their particular
  source of anxiety but actually seek it out.
  Eventually, emotional nerve endings grow
  desensitized to the stimulus.
• Cognitive Perspective
• Overreact to unwanted thoughts
• Try to neutralize these thoughts with actions
• If neutralizing activity reduces anxiety, it
  becomes reinforced
• Biological Perspective
• Twin studies genetic component
• 53 in identical twins
• 23 in fraternal twins
• Brain abnormalities
• Too much glutamate, which causes the alarm
  centers in the brain to keep going off
• Lack of serotonin functioning (NT involved with
  regulation of sleep and mood
• High level of activity in frontal lobes,
  associated with attention

High metabolic activity (red) in frontal lobes
44
Causes of Stress Disorders

• Combat
• Disasters
• Abuse and victimization
• Why doesnt everyone develop psychological stress
  disorders?
• Biological and genetic factors
• Physical changes in body
• Abnormal NT and hormonal activity
• Personality factors
• Preexisting high anxiety
• History of psychological problems
• Negative worldview
• Negative childhood experiences
• Weak social support
• Severity of the trauma

• Psychological Debriefing
• Normalize responses to the disaster
• Encourage expressions of anxiety, anger, and
  frustration
• Teach self-help skills
• Provide referrals

45
Additional Anxiety Disorder Videos

• OCD Videos
• http//www.metacafe.com/watch/84755/true_life_livi
  ng_with_ocd/
• http//www.metacafe.com/watch/yt-SH0r44qn6pI/my_li
  fe_with_ocd_laurens_story_part_i_dramatic_health/
• http//www.metacafe.com/watch/yt-T0FMXyp6ZEs/my_li
  fe_with_ocd_laurens_story_part_ii_dramatic_health/
  
• PTSD Videos
• http//www.mtv.com/videos/true-life-i-have-post-tr
  aumatic-stress-disorder/1601333/playlist.jhtml

46
Mood Disorders

• Emotional extremes, which come in two principal
  forms.

• Unipolar disorders experience emotional
  extremes at just one end of the mood continuum
• Major depressive disorder
• Dysthymic disorder
• Seasonal Affective disorder
• Bipolar disorders experience emotional extremes
  at both ends of the mood continuum depression
  and mania

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Major Depressive Disorder

• Symptoms
• Signs of depression last two weeks or more and
  are not caused by drugs or medical conditions
• Signs include Lethargy and fatigue (takes
  tremendous effort to get up and get dressed)
  feelings of worthlessness (tearfulness and
  weeping exaggerate minor failings, discount
  positive events, interpret things that go wrong
  as evidence that nothing will ever go right)
  loss of interest in family friends recurrent
  thoughts of death/suicide loss of interest in
  activities depressed most of the day
  significant weight gain/loss insomnia
  psychomotor agitation/retardation concentration
  difficulties or indecisiveness

I was seized with an unspeakable physical
weariness. There was a tired feeling in the
muscles unlike anything I had ever experienced
my nights were sleepless. I lay with dry,
staring eyes gazing into space. The most trivial
duty became a formidable task. Finally mental
and physical exercises were impossible the tired
muscles refused to respond, my thinking
apparatus refused to work, ambition was gone.
My general feeling might be summed up in the
familiar saying Whats the use.
48
Dysthymic Disorder

• Symptoms
• Mild but chronic lies between a blue mood and
  major depressive disorder
• Characterized by daily depression lasting two
  years or more longer lasting but less disabling
• When dysthymic disorder leads to major depressive
  disorder, the sequence is called double
  depression

49
Seasonal Affective Disorder

• Symptoms
• Depression on a recurring basis in one season of
  the year when it gets dark early and light late
  in the day
• Treatment
• Light Therapy exposure to bright light for a
  specific length of time
• The level of light produced must match that of
  visible light outdoors shortly after sunrise or
  before sunset

50
Etiology of Mood Disorders

• Biological
• Genetic runs in families
• Low serotonin may open the door to a mood
  disorder and permit norepinephrine activity to
  define the particular form the disorder will
  take
• Low serotonin Low norepinephrine Depression
• Low serotonin High norepinephrine Mania.
• An excessive release of the stress hormone
  cortisol, which could be connected to impaired
  functioning of the hypothalamus and pituitary
  gland of the endocrine system
• Malfunctions in the bodys circadian clock,
  specifically for SAD.
• Socio-cultural
• Dysfunctional family systems, poverty, high-crime
  neighborhoods, domestic violence, and other
  stressful situations
• Women have a higher chance than men of developing
  a mood disorder

• Psychodynamic
• Link between depression and grief when a loved
  one dies, the mourner regresses to the oral
  stage
• Cognitive
• Ruminating response style, self-defeating
  thoughts, external locus of control, learned
  helplessness, and pessimistic views of
  themselves, the world, the future.

51
Treatment of Mood Disorders

• Cognitive-Behavioral Therapy
• Combine the reversal of self-defeated thinking
  with efforts to modify behavior. Aims to alter
  the way people act (behavior therapy) and alter
  the way they think (cognitive therapy).
• Lewinsohns Behavioral Treatment
• reintroduce clients to pleasurable activities and
  events
• appropriately reinforce their depressive and
  nondepressive behaviors
• help them improve their social skills

• Cognitive
• Aaron Becks Cognitive Therapy depression is
  caused by errors in thinking - illogical thinking
  about themselves, the world they live in, and the
  future. In therapy, clients are taught not only
  to identify negative, distorted thoughts but also
  to actually go out and test those negative
  beliefs. EX a client who believes that nobody
  likes him will be instructed to engage in
  conversations with other people and report back
  with all of his experiences, which the therapist
  will try to build on successes and explore
  reasons for lack of success.
• Albert Ellis Rational Emotive Behavior Therapy
  (RET) Emotional disorders are caused by
  irrational beliefs - absolute, unrealistic views
  of the world and perfectionistic - that cause us
  to expect too much of ourselves and lead us to
  feel unnecessarily that we are worthless
  failures. Therapists identify clients
  irrational beliefs and directly challenge or
  confront the patient and persuade them to adopt
  more realistic beliefs.
• Stress Inoculation Training - A type of
  self-instructional training focused on altering
  self-statements an individual routinely makes in
  stress producing situations. EX Relax, the
  exam may be hard, but it will be hard for
  everyone else too. I studied harder than most
  people. Besides, I dont need a perfect score to
  get a good grade.

52
Treatment of Mood Disorders
Biological Monoamine Oxidase (MAO) inhibitors
elevate levels of norepinephrine and serotonin by
blocking or inhibiting the enzyme that
deactivates these NT. Serotonin-norepinephrin
e inhibitors (SNRIs) also elevate levels of
norepinephrine and serotonin by blocking the
reuptake of these NT.
Pre-synaptic Neuron
Serotonin
Norepinephrine
Post-synaptic Neuron
Selective serotonin reuptake inhibitors (SSRIs)
(Prozac, Zoloft, and Paxil) elevate levels of
serotonin by preventing its reuptake
53
Treatment of Mood Disorders

• Electroconvulsive Therapy (ECT)
• ECT is used for severely depressed patients who
  do not respond to drugs. The patient is
  anesthetized and given a muscle relaxant.
  Patients usually get a 100 volt shock that
  relieves them of depression.

Transcranial Magnetic Stimulation (TMS) In TMS, a
pulsating magnetic coil is placed over prefrontal
regions of the brain to treat depression with
minimal side effects.
54
Treatment of Mood Disorders
Psychosurgery was popular even in Neolithic
times. Although used sparingly today, about 200
such operations do take place in the US alone.
Psychosurgery is used as a last resort in
alleviating psychological disturbances.
Psychosurgery is irreversible. Removal of brain
tissue changes the mind. Modern methods use
stereotactic neurosurgery and radiosurgery that
refine older methods of psychosurgery.
55
Unipolar Disorders results from

• Biological Perspective
• Low norepinephrine (a stress hormone which
  affects parts of the brain where attention and
  responding actions are controlled. Underlies
  fight or flight response) and/or low serotonin
  levels
• Brain scans show reduced frontal lobe activity
• Mood disorders run in families. The rate of
  depression is higher in identical (50) than
  fraternal twins (20).
• Linkage analysis and association studies link
  possible genes and dispositions for depression.

56
Unipolar Disorders results from

• Psychodynamic Perspective
• Link between depression and grief when a loved
  one dies, the mourner regresses to the oral stage
• For most people, grief is temporary
• If grief is severe and long-lasting, depression
  results
• Those with oral stage issues (unmet or
  excessively met needs) are at greater risk for
  developing depression
• Behavioral Perspective
• Depression results from changes in rewards and
  punishments people receive in their lives social
  rewards are especially important
• Sociocultural Perspective
• Focus on conditions of peoples lives may
  explain gender differences in depression rates.
  Also found links between depression and culture,
  race, and social support
• Marriage and employment associated with lower
  rates of depression
• People with depression experience a greater
  number of stressful life events during the month
  just prior to the onset of their symptoms

57
Unipolar Disorders results from

• Cognitive Perspective
• Conscious thoughts how a person attends to,
  interprets, and uses information
• Learned maladaptive thought patterns cause mental
  disorder (maladaptive thinking ? maladaptive
  behavior)
• Ruminating response style - depressed people
  hold pessimistic views of themselves, the
  world, the future and distort their experiences
  in negative ways exaggerate bad experiences,
  minimize good experiences.
• Learned helplessness - people become depressed
  when their efforts to avoid pain or control the
  environment fail however, not all depressed
  people have actually experienced failure
  (social-cognitive)

58
Explanatory Style and Depression Cycle

1. Negative stressful events.
2. Pessimistic explanatory style.
3. Learned helplessness/Hopeless depressed state.
4. These hamper the way the individual thinks and
   acts, fueling personal rejection.

59
Social-Cognitive Perspective
The social-cognitive perspective suggests that
depression arises partly from self-defeating
beliefs and negative explanatory styles.
60
Rational Emotive Therapy (RET)

• Albert Ellis
• Emotional disorders are caused by irrational
  beliefs - absolute, unrealistic views of the
  world and perfectionistic values (i.e. Everyone
  must love me all of the time. or I should be
  thoroughly adequate and competent in
  everything.) that cause us to expect too much
  of ourselves and lead us to feel unnecessarily
  that we are worthless failures
• Clients are taught that it is not the external
  events, but the interpretation of such events
  that leads to feeling of despair. 1) Therapists
  search for a clients irrational beliefs,
  especially with respect to the irrational
  shoulds, oughts, and musts that are
  preventing a more positive sense of self worth
  and a fulfilling life, 2) points out the
  impossibility of fulfilling them, and 3) uses any
  and every technique to persuade the client to
  adopt more realistic beliefs, such as directly
  challenging/confronting the clients beliefs
  during therapy

ABC Model A Activating Event (the individual
cannot find a date for the prom) B Belief,
irrational (I guess nobody likes me enough to go
with me to the prom) C Consequences (Feelings
of depression). Ellis would challenge
irrational beliefs with rational arguments and
provide other reasons why he or she doesnt have
a date for the prom, because the thought is
causing the depression not the event.
61
Rational Emotive Therapy (RET)
62
Cognitive Therapy

• Aaron Beck
• Depression is caused by errors in thinking -
  illogical thinking about themselves, the world
  they live in, and the future which lead them
  to
• 1) selectively perceive the world as harmful
  while ignoring evidence to the contrary
• 2) overgeneralize on the basis of limited
  examples for example, seeing themselves as
  totally worthless because they were laid off at
  work,
• 3) magnify the significance of undesirable events
  for example, seeing the job loss as the end of
  the world for them,
• 4) engage in absolutistic thinking for example,
  exaggerating the importance of someones mildly
  critical comment and perceiving it as proof of
  their instant descent from goodness to
  worthlessness
• Clients are taught not only to identify negative,
  distorted thoughts but also to actually go out
  and test those negative beliefs.
• First taught to simply identify their own
  automatic thoughts (e.g. This event is a total
  disaster.) and to keep records of their thought
  content and their emotional reactions.
• With the therapists help, they then learn about
  the logical errors in their thinking, and to
  challenge the validity of these automatic
  thoughts by designing ways in which the client
  can check out these thoughts in the real world.
  These disconfirmation experiments are planned to
  give the individual successful experiences, thus
  interrupting the destructive thought sequence. .
• EX a client who believes that nobody likes him
  will be instructed to engage in conversations
  with other people and report back with all of his
  experiences, which the therapist will try to
  build on successes and explore reasons for lack
  of success.

63
Cognitive Therapy
64
Bipolar Disorder(formerly called
manic-depressive disorder)

• An alternation between depression and mania
  signals bipolar disorder.

Manic Symptoms
Depressive Symptoms
Elation
Gloomy
Euphoria
Withdrawn
Desire for action
Inability to make decisions
Hyperactive
Tired
Multiple ideas
Slowness of thought
65
Types of Bipolar Disorder

• Manic Episode
• Three or more symptoms of mania lasting one week
  or more
• Hypomanic Episode
• a less severe version of a manic episode that
  does not cause marked impairment in social or
  occupational functioning
• Bipolar I Disorder
• Full manic and major depressive episodes
• Most sufferers experience an alternation of
  episodes
• Some experience mixed episodes
• Bipolar II Disorder
• Hypomanic episodes and major depressive episodes
• Cyclothymic Disorder
• a chronic pattern of less-severe mood swings
• hypomania
• mild depression
• may blossom into bipolar I or II disorder

When experiencing manic symptoms, a 38 year old
woman, periodically hospitalized because of her
extreme moods, would become overactive and
exuberant in spirits and visited her friends, to
whom she outlined her plans for reestablishing
different forms of lucrative business. She
purchased many clothes, bought furniture, pawned
rings, and wrote checks without funds. She
played her radio until late in the night, smoked
excessively, took out insurance on a car that she
had not yet bought. Contrary to her usual
habits, she swore frequently and loudly and
created a disturbance in a club to which she did
not belong. On the day prior to her second
admission to the hospital, she purchased 57 hats.

66
Bipolar Disorder
Many great writers, poets, and composers suffered
from bipolar disorder. During their manic phase
creativity surged, but not during their depressed
phase.
Earl Theissen/ Hulton Getty Pictures Library
George C. Beresford/ Hulton Getty Pictures Library
The Granger Collection
Bettmann/ Corbis
67
Bipolar Disorder results from

• Biological Perspective
• Low serotonin may open the door to a mood
  disorder and permit norepinephrine activity to
  define the particular form the disorder will
  take
• Low serotonin Low norepinephrine Depression
• Low serotonin High norepinephrine Mania.
  Excessive production of norepinephrine.
• Ions, which are needed to send incoming messages
  to nerve endings, may be improperly transported
  through the cells of individuals with bipolar
  disorder this improper transport may cause
  neurons to fire too easily (mania) or to resist
  firing (depression)
• PET scans show that brain energy consumption
  rises and falls with manic and depressive
  episodes.

Lithium Carbonate, a common salt, has been used
to stabilize manic episodes in bipolar disorders.
It moderates the levels of norepinephrine and
glutamate neurotransmitters.
68
Schizophrenia

• Symptoms The literal translation is split
  mind. A group of severe disorders characterized
  by the following
• Disorganized thinking (neologisms, clang/loose
  associations, word salad)
• Delusions and hallucinations.
• Inappropriate emotions and actions.
  http//www.youtube.com/watch?vtvkj1qlQ9vMfeature
  related

This morning when I was at Hillside Hospital, I
was making a movie. I was surrounded by movie
stars Im Marry Poppins. Is this room painted
blue to get me upset? My grandmother died four
weeks after my eighteenth birthday.
This monologue illustrates fragmented, bizarre
thinking with distorted beliefs called delusions
(Im Mary Poppins).
69
Subtypes of Schizophrenia

• Schizophrenia is a cluster of disorders. These
  subtypes share some features, but there are other
  symptoms that differentiate these subtypes.

70
Schizophrenia Symptoms
Inappropriate symptoms present (positive symptoms behavioral excesses) Appropriate symptoms absent (negative symptoms behavioral deficitis)
Hallucinations, disorganized thinking, deluded ways. Apathy, (avolition no emotion), expressionless faces, rigid bodies blunted or flat affect, social withdrawal, poverty of speech (alogia) .
When schizophrenia rapidly develops
(acute/reactive) recovery is better. Such
schizophrenics usually show positive symptoms.
When schizophrenia is slow to develop
(chronic/process) recovery is doubtful. Such
schizophrenics usually display negative symptoms.
71
Positive Symptoms (Behavioral Excesses)

• Schizophrenics have inappropriate symptoms
  (hallucinations, disorganized thinking, deluded
  ways) that are not present in normal individuals
• Delusions false beliefs about reality
• delusions of grandeur GOD complex/meglomania
  people maintain that they are famous or important
• delusions of persecution theyre out to get me/
  paranoia
• delusions of being controlled the CIA is
  controlling my brain with a radio signal
• Disordered thought speech - Many psychologists
  believe disorganized thoughts occur because of
  selective attention failure (fragmented and
  bizarre thoughts).
• loose associations/derailment people shift
  topics in disjointed ways.
• neologisms meaningless, made up words
• Perseveration repetition of speech
• thought insertion
• thought broadcasting
• Heightened perception
• Hallucinations - A schizophrenic person may
  perceive things that are not there. Frequently
  such hallucinations are auditory and lesser
  visual, somatosensory, olfactory, or gustatory.
  Sensory perceptions that occur in the absence of
  sensory stimulus
• Inappropriate affect - A schizophrenic person may
  laugh at the news of someone dying

72
Psychomotor Symptoms

• Awkward movements, repeated grimaces, odd
  gestures
• Movements seem to have a magical quality
• Catatonia extreme form
• includes stupor, rigidity, posturing, and
  excitement - patients with schizophrenia may
  continually rub an arm, rock a chair, or remain
  motionless for hours

73
Schizophrenia
Nearly 1 in a 100 suffer from schizophrenia, and
throughout the world over 24 million people
suffer from this disease (WHO, 2002).

• Schizophrenia strikes young people as they mature
  into adults. It affects men and women equally,
  but men suffer from it more severely and it
  appears earlier than women.
• More common among the poor. Stress of poverty
  might cause the disorder or schizophrenia causes
  victims from higher social levels to fall to
  lower social levels (downward drift theory)

74
Etiology of Schizophrenia

• Biological
• Genetic runs in families.
• Increased size in the ventricles (negative
  symptoms)
• Dopamine Hypothesis Excessive dopamine or
  excessive receptor sites for dopamine is
  connected to the positive symptoms..
• Prenatal viruses, such as influenza, or physical
  trauma during fetal development.
• Socio-cultural
• Dysfunctional family systems display conflict,
  verbal exchanges are often confused, vague or
  incomplete, critical and overly involved parents
• Substance abusers are more likely to develop
  disorder, such as cocaine users.
• Disadvantaged communities report more incidences
  of disorder than better-off areas..
• Vulnerability theory of schizophrenia
  (diathesis-stress model) schizophrenia is the
  result of a biological predisposition and the
  amount of stress one encounters.

• Behavioral
• Some people are not reinforced for their
  attention to social cues and, as a result, they
  stop attending to those cues and focus instead on
  irrelevant cues (e.g., room lighting) and their
  responses become increasingly bizarre
• Cognitive
• Faulty interpretation and a misunderstanding of
  biological events (EX a man experiences auditory
  hallucinations and approaches his friends for
  help they deny the reality of his sensations he
  concludes that they are trying to hide the truth
  from him he begins to reject all feedback and
  starts feeling persecuted)

75
Treatment of Schizophrenia
Biological
Classical antipsychotics Chlorpromazine
(Thorazine) blocks all receptor sites for
dopamine thereby lessening the effects of
dopamine and removing a number of positive
symptoms associated with schizophrenia such as
agitation, delusions, and hallucinations. Also
known as neuroleptic drugs because they often
produce undesired movement effects similar to
symptoms of neurological diseases, such Tardive
Dyskinesia (involuntary movements, usually of the
mouth, lips, tongue, legs, or body)
Atypical antipsychotic drugs Clozapine
(Clozaril) also blocks receptors for dopamine,
but selectively blocks some of them and not all
of them thereby, eliminating some of the
negative side effects of classic antipsychotics
(i.e. has less of an effect on the D-2 receptors
which control body movements, so it does not
cause symptoms like Parkinson's disease). Also
blocks serotonin receptors
76
Treatment of Schizophrenia

• Socio-Cultural Perspective
• Family Therapy attempts to address the issues of
  living with a schizophrenic, creating more
  realistic expectations, and providing
  psychoeducation about the disorder
• Social Therapy focuses on techniques that address
  social and personal difficulties in the clients
  lives (e.g., practical advice, problem solving,
  decision making, social skills training,
  medication management, employment counseling,
  financial assistance, and housing

77
Schizophrenia results from

• Psychodynamic Perspective
• Freud believed that schizophrenia developed from
  two processes
• regression to a pre-ego stage
• efforts to re-establish ego control
• Behavioral Perspective
• Cites principles of reinforcement as the cause
  some people are not reinforced for their
  attention to social cues and, as a result, they
  stop attending to those cues and focus instead on
  irrelevant cues (e.g., room lighting) and their
  responses become increasingly bizarre
• Cognitive Perspective
• Schizophrenic symptoms develop because of faulty
  interpretation and a misunderstanding of
  biological events (EX a man experiences auditory
  hallucinations and approaches his friends for
  help they deny the reality of his sensations he
  concludes that they are trying to hide the truth
  from him he begins to reject all feedback and
  starts feeling persecuted)

78
Schizophrenia results from

• Biological Perspective
• Twin studies genetic component
• Risk of schiz for general population is 1-2
  percent
• The likelihood of an individual suffering from
  schizophrenia is 50 if their identical twin has
  the disease
• No specific genes for schiz have been identified

79
Schizophrenia results from

• Biological Perspective
• Schizophrenia may develop through 2 kinds of
  biological abnormalities
• Dopamine Overactivity Hypothesis
• neurons using dopamine fire too often, producing
  symptoms of schizophrenia
• there are an unusually large number of dopamine
  receptors in people with schizophrenia
• take antipsychotic meds, which block dopamine and
  help with positive symptoms
• may have low levels of serotonin, which may lead
  to high levels of dopamine activity.
• Brain abnormaliti