ABNORMAL PSYCHOLOGY PSYCHOLOGICAL DISORDERS TREATMENT AND THERAPY

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ABNORMAL PSYCHOLOGYPSYCHOLOGICAL
DISORDERSTREATMENT AND THERAPY

• Chapters 15 and 16

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Abnormal Behavior

• The Medical (biological) Model
• Other models
• -Behavioral -Psychoanalytic -Cognitive
• -Humanistic-existential -Bio-psycho-social
• Criteria of Abnormality
• Deviance from social norms
• Maladaptive behavior
• Personal distress
• Myers atypical disturbing
• maladaptive unjustifiable

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In the beginning

• Medical Model it is useful to think of abnormal
  behavior as a disease i.e. how we refer to
  mental illness, disorders, and psychopathology.
  Before this abnormal behavior was based on
  superstition i.e. possession by devil.
• Diagnosis involves distinguishing one illness
  from another
• Etiology refers to the apparent causation and
  developmental history of an illness
• Prognosis a forecast about the probable course
  of an illness
• Thomas Szasz asserts that strictly speaking,
  disease or illness can affect only the body
  hence there can be no mental illness since
  abnormal behavior is actually a deviation from
  SOCIAL norms they are problems in living not
  actual illnesses.

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Psychological Disorders
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Rates of Psychological Disorders
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Stereotypes and Myths

• Psychological disorders are incurable yes, some
  never make it back into society but the majority
  of people do get better
• Mentally ill people are violent and dangerous
  only a modest association has been found between
  illness and violence. Media?
• Mentally ill people behave in bizarre ways and
  very differently from normal people only a
  small minority of cases

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• The Diagnostic System
• DSM IV
• (I) CLINICAL SYNDROMES
• (II) PERSONALITY DISORDERS
• (III) GENERAL MEDICAL CONDITIONS
• (IV) PSYCHOSOCIAL STRESSORS
• (V) GLOBAL ASSESSMENT OF FUNCTIONING

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Disorders
Anxiety Disorder 2nd most common disorder
(Substance abuse is 1st) Afflicts about 1 in 6
Americansmore than 32 million people (U.S.)
Common Characteristics include FEAR, feeling
tense, easily startled, constant worriers.
Behavior is self defeating.
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Anxiety Disorders

• Types
• Panic Disorder
• Generalized Anxiety Disorder
• Post Traumatic Stress Disorder (PTSD)
• Separation Anxiety Disorder
• Phobias
• Obsessive-Compulsive Disorder
• http//www.learner.org/vod/vod_window.html?pid778

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PHOBIAS Disabled and overwhelmed by fear of
specific object or event. Most common is
agoraphobia followed by animals. Treatments
cognitive, behavioral, biological
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Anxiety Disorders

• Common and uncommon fears Phobias

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Panic Disorder
Frequent and overwhelming attacks of anxiety
Breathing, Heart rate, Doom
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Obsessive-Compulsive Anxiety is reflected in
persistent, unwanted and unshakable thoughts or
repeated actions. The action does make it go
away for a little while, but when it returns you
find yourself repeating the same routine over.
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OCD

• Common in every lifebecomes neurotic when it
  interferes with adjustment
• Compulsionsymbolic, ritualized behavior
• Obsessionendless preoccupation with some type of
  urge or thought
• Results from faulty attempts to resolve guilt,
  anxiety or insecurity

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Anxiety Disorders
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• Why?
• Serve as a diversion from real fears
• Provide person with evidence that she is doing
  something well, even if it is avoiding cracks on
  a sidewalk.
• Biological Anxiety declines in older age and
  medication has been shown to help.

1990 a woman was reported washing her hands 500x
a day
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Anxiety Disorders OCD
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Anxiety Disorders

• PET Scan of brain of person with Obsessive/
  Compulsive disorder
• High metabolic activity (red) in frontal lobe
  areas involved with directing attention

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Posttraumatic Stress Disorder People who
experience an event outside the normal range of
human experience often exhibit a range of
severely distr-essing symptoms.
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PTSD

• Flashbacks, nightmares, guilt, anxiety
• Tied to specific event (War, Natural disaster,
  accident, rape, etc.)
• Biologicaloveractive amygdala
• Psychodynamicincomplete repression
• Medicines, therapy, beta blockers

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Etiology

• Twins genetic predisposition
• Neural circuits using GABA
• Acquired thru classical maintained thru operant
  conditioning
• Cognitive theorists over-interpret harmless
  situations as threatening
• High neuroticism exposure to great stress

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Biomedical Therapies

• Psychopharmacology
• study of the effects of drugs on mind and
  behavior
• Anti-anxiety drugs Zoloft, Buspar, Ativan,
  Xanax, Valium, Paxil

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Behavior Therapy

• Systematic Desensitization

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Behavior Therapy

• Aversion therapy for alcoholics

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Cognitive Therapy

• The Cognitive Revolution

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Rational Emotive therapy Cognitive Therapy

• REBT employs the ABC framework depicted in
  the figure below to clarify the relationship
  between activating events (A) our beliefs about
  them (B) and the cognitive, emotional or
  behavioural consequences of our beliefs (C). The
  ABC model is also used in some renditions of
  cognitive therapy or cognitive behavioural
  therapy, where it is also applied to clarify the
  role of mental activities or predispositions in
  mediating between experiences and emotional
  responses.
• The figure below shows how the framework
  distinguishes between the effects of rational
  beliefs about negative events, which give rise to
  healthy negative emotions, and the effects of
  irrational beliefs about negative events, which
  lead to unhealthy negative emotions.

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Rational Emotive Therapy (cont)

• The main purpose of REBT is to help clients to
  replace absolutist philosophies, full of musts
  and shoulds, with more flexible ones part of
  this includes learning to accept that all human
  beings (including themselves) are fallible and
  learning to increase their tolerance for
  frustration while aiming to achieve their goals.
• Three primary insights
• While external events are of undoubted influence,
  psychological disturbance is largely a matter of
  personal choice in the sense that individuals
  consciously or unconsciously select both rational
  beliefs and irrational beliefs at (B) when
  negative events occur at (A)
• Past history and present life conditions strongly
  affect the person, but they do not, in and of
  themselves, disturb the person rather, it is the
  individuals responses which disturb them, and it
  is again a matter of individual choice whether to
  maintain the philosophies at (B) which cause
  disturbance.
• Modifying the philosophies at (B) requires
  persistence and hard work, but it can be done.

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Becks Cognitive therapy--

• Aaron Beck developed a treatment for anxiety and
  depression based on cognitive theory. Patients
  tune into their internal dialogue in order to
  change maladaptive thinking patterns. Beck
  developed specific procedures to help challenge a
  client's assumptions and beliefs. Patients learn
  how to change their thinking.

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Psychoanalytic Treatment

• Free association
• Dream analysis
• Hypnosis
• Insight therapy therapist suggests insights to
  patients problems goal is to gain insight to
  underlying issues of problems
• Interpretation of resistance (blocking anxiety
  laden material from consciousness)/transference
  (transfer to the analyst the emotions linked to
  other important relationships)

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Mood Disorders (Affective Disorders) Depression
is the primary symptom. Major mood disorders
major depression, dysthymic disorder, bipolar
disorder, seasonal affective disorder. Differentia
ted from normal moods by duration, intensity,
lack of cause. More common in women Greatest
risk 15-24 and 35-44 Episodes reoccur in half
of cases
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Mood Disorders

• Major Depression
• Sadness, hopelessness, guilt emotionally
  disconnected
• Dysthymic Disorder
• Chronic, but low grade
• Seasonal Affective Disorder (SAD)
• Symptoms appear in fall and winter phototherapy
• Bipolar Disorder (Manic-Depressive Disorder)
• Major depression and Mania
• Behavioral and cognitive symptoms
• Onset in early 20s
• Drug therapylithium
• http//www.learner.org/vod/vod_window.html?pid786
  

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Etiology

• Twin studies suggest genetic predisposition
• Neural circuits using Serotonin Norepinephrine
• Cognitive theorists pessimistic view
• Behavioral theorists inadequate social skills
• High stress

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What do these people have in common?
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The word depression causes confusion. Bad moods
are part of life, clinical depression can kill
you. It affects 1/20 Americans a year. Signs
dont feel hopeful or happy about anything, slow
motion, nothing tastes good, getting up requires
great effort
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Mood Disorders-Depression
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Mood Disorders-DepressionSocial-cognitive
explanation

• Self-defeating beliefs
• Learned helplessness
• Negative thoughts feed negative moods
• Negative moods feed negative thoughts

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Mood Disorders-Depression Social-cognitive
explanation

• The vicious Cycle of Depression can be broken at
  any point!

(negative)
(thoughts or actions)
(pessimism)
(hopeless)
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Mood Disorders-Depression

• Altering any one component of the
  chemistry-cognition or mood circuit can alter the
  others

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Mood Disorders- Suicide
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Seasonal Affective Disorder Winter
depression-weight gain, over sleeping,
overeating, and craving carbohydrates (deficient
exposure to light) Summer depression-loss of
appetite, weight loss, insomnia (heat is the
triggering factor)
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Bipolar Disorder Characterized by extreme mood
swings, depression to euphoria Not triggered by
identifiable events a.k.a. manic
depression Mania-inflated self-esteem or
Grandiosity. Cannot have mania alone. what
goes up must come down Mania goes through three
stages hypomania, mania, severe mania
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Mood Disorders-Bipolar

• PET scans show that brain energy consumption
  rises and falls with emotional switches

May 17
May 18
May 27
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Biomedical Therapies
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Biomedical Therapies

• Electroconvulsive Therapy (ECT)
• therapy for severely depressed patients in which
  a brief electric current is sent through the
  brain of an anesthetized patient
• Psychosurgery
• surgery that removes or destroys brain tissue in
  an effort to change behavior
• lobotomy
• now-rare psychosurgical procedure once used to
  calm uncontrollably emotional or violent patients
  

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Cognitive Therapy

• A cognitive perspective on psychological disorders

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Cognitive Therapy
Depression scores

• Cognitive therapy for depression

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Cognitive behavior therapy

• Combines treating thinking patterns with changing
  patients behavior
• It seeks to make people aware of their negative
  thinking and to replace it with new ways of
  thinking, and the practice a more positive
  approach in everyday settings.

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Somatoform Disorders

• SYMPTOMS bodily symptoms without physical
  problem
• Conversion Disorder
• Hysterical blindness
• Hysterical paralysis
• Hypochondriaoverly concerned with
  health/exaggerate minor physical complaints

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Conversion Disorder Emotional difficulties into
loss of physiological function. Unconsciously
invent physical symptoms to gain freedom of
unbearable conflict. Common sites for sensory
conversions
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Etiology

• Histrionic personality traits
• Cognitive theorists
• excessive attention on body sensations
• unrealistic standard of good health
• Sick role

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Dissociative Disorder
A disturbance in conscious awareness, such as
identity or memory Psychogenic Amnesia sudden
loss of memory, may be an attempt to escape from
a problem, retain general knowledge Psychogenic
Fugue combines amnesia with flight- wake up 200
miles away from home have a new identity,
marriage, and job, lasts from days to years.
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Dissociative Disorder

• EXTREMELY RARE
• SYMPTOMS memory loss disconnection from
  personal identity disconnect events from one
  another
• Psychogenic Amnesia
• Selective forgetting Usually psychological
  benefit for forgetting
• Psychogenic Fugue
• Complicated type of amnesia
• More common in men
• Disappear and start new life
• MPD/DID (MultiplesDissociative Identity
  Disorder)
• Extremely rare
• Haunted, confused personality
• Childhood abuse
• Long-term habit of escaping

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Personality Disorders

• Personality Disorders
• disorders characterized by inflexible and
  enduring behavior patterns that impair social
  functioning
• usually without anxiety, depression, or delusions
• http//www.learner.org/vod/vod_window.html?pid780

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Personality Disorders

• SYMPTOMS peculiar and unpleasant personality
  patterns (Off-center)
• Clusters
• Antisocial Personality (Psychopaths)
• Conflict with law, Manipulative, impulsive,
  superficial emotion, no conscience
• Borderline
• Intense and unstable relationships, dependent,
  clingy, self-destructive very difficult to treat
• Miscellaneous
• Narcissistic, Paranoid, Schizoid, Histrionic

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Personality Disorders

• PET scans illustrate reduced activation in a
  murderers frontal cortex

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Personality Disorders
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And Finally Schizophrenia

• Defined as a class of disorders marked by
  delusions, hallucinations, disorganized speech,
  and deterioration of adaptive behavior
• It primarily involves disturbances in perception
  and thought, with corresponding loss of the
  ability to function.
• Cognitive processes are severely disrupted.
• Positive symptoms Hallucinations, disorganized
  and delusional talk, inappropriate laughter,
  tears, or rage.
• Negative symptoms toneless voices,
  expressionless faces, mute
• http//www.learner.org/vod/vod_window.html?pid788
  

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Schizophrenia NO two sufferers of schizophrenia
suffer the same symptoms. It is the disorder we
characterize with crazy, psychotic, or
insane. There are as many people with
schizophrenia as there are people in Hawaii! (1
in 100) Rule of thirds Statistically, one
third of all diagnosed will recover completely,
one third will improve over time and one third
will not improve.
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Etiology of Schizophrenia

• Genetic 48 identical 17 fraternal twins
• Born to parents with Schizophrenia 46
• Emerge during adolescence or early
  (15-24)adulthood and sometimes at 45 its either
  sudden or gradual
• Excess dopamine but new research is not
  conclusive
• Inability to filter out unimportant stimuli,
  large brain ventricles, new research with the
  thalamus is smaller with less metabolic activity
• Neurodevelopment hypothesis phases of pregnancy
  during the flu season
• Precipitating stress and unhealthy family dynamics

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More Specifically

• Whats the cause?
• Levels of dopamine
• 4x more likely if someone in family has it
• Prenatal or birth trauma
• Viral infections or lack of nutrition as infants
• 2x more likely when born in urban areas

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Schizophrenia
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Etiology

• Twin adoption studies
• Dopamine
• Neuro-developmental hypothesis
• Relapse (residual) rates
• Stress

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Does Therapy Work?

• Meta-analysis
• procedure for statistically combining the results
  of many different research studies

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Mental Illness v. Insanity

• Mental illness is a medical decision.
• Insanity is a legal one. To be considered insane
  a person must be unable to control his/her
  behavior and be unaware that his behavior is
  wrong.

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Pathology the Law

• Insanity
• Insanity defense
• Involuntary commitment
• Culture Pathology
• Relativistic view
• Pan-cultural view

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DSM-IV

• Impulse control disorders impulsive behaviors
  harm the self or others. Ex. Intermittent
  explosive disorder, kleptomania, pathological
  gambling.
• Disorders 1st diagnosed in infancy, childhood,
  adolescence appear before adulthood Ex. Mental
  retardation, learning disorders, and language
  development

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DSM-IV

• Adjustment disorders extreme emotional reaction
  to a stressor that occurred w/in the previous
  month (much greater than most people would
  experience).
• Personality disorders long-term disorders with
  rigid, maladaptive personality traits. Ex.
  Antisocial personality D, histrionic personality
  D, narcissistic PD
• Delirium, dementia, amnestic and other cognitive
  Disorders diverse group of memory and cognition
  that is caused by identifiable brain damage. Ex.
  Alzheimers, intellectual impairment (stroke),
  delirium (change in consciousness) due to overdose

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Major Psychological Disorders of Axis 1
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Major Psychological Disorders of Axis 1
(continued)
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Different dimensions or axes

• Each axis reflects a different aspect of a
  patients case
• Axis I- used to classify current symptoms
• Axis II- used to describe developmental and
  long-standing personality disorders or
  maladaptive traits specific developmental
  disorders for children such as mental
  retardation, autism, etc.
• Axis III- used to describe physical disorders or
  general medical conditions that are relevant to
  treatment
• Axis IV- current stress level (based on the past
  year)
• Axis V- adaptive functioning 3 major areas
  social relations, occupational functioning, use
  of leisure time