Some Mental Disorders

1. Some Mental Disorders Shulin Chen, MD & PhD Zhejiang University Hangzhou Mental Health Center

2. Outline • Stress • Anxiety and OCD • Somatoform and Dissociative disorders

3. Stress-Related Disorders

4. Categories of Stressors • Frustrations • Conflicts • Approach-avoidance • Double approach • Double avoidance • Pressures • internal and external

6. Factors Predisposing a Person to Stress - Stressor characteristics • Duration (acute versus chronic) • Number of stressors • Severity (“size” of the stressor)

7. Psychological Moderators of Stress • Self-efficacy • Psychological hardiness • commitment; high in challenge • Sense of humor • Predictability and controllability • Social support • Task oriented versus defense oriented coping

8. Effects of Stress • Physical effects • Physiological effects • General Adaptation Syndrome • Alarm stage • Resistance stage • Exhaustion state

9. Stress-Related Disorders:Adjustment Disorders • Adjustment Disorders • Mild • A maladaptive reaction to an identifiable psychosocial stressor • Typical sources of stress: • unemployment • relocation

10. Disaster Syndrome • Characterizes the initial reactions of many victims to catastrophes • Stages: • Shock • Suggestible • Recovery

11. Acute Stress Disorder and PostTraumatic Stress Disorder • Similar symptoms, but “time-frame” of symptoms differ. • Both occur in reaction to traumatic events (e.g., natural disasters, rape, assault, war, etc). • Acute stress disorder, if it lasts past one month, will turn into a diagnosis of PTSD.

12. PTSD:General Categories of Symptoms • Reexperiencing of the traumatic event • Avoidance of stimuli associated with the event. • Numbing of general responsiveness • Increased arousal

13. PTSD:Vulnerability Factors • Premorbid personality • pre-existing psychological problems, low self-esteem, social skill deficits, external locus of control. • Severity of trauma • Conditioned fear • Childhood factors • Poverty, early divorce or separation, family history of mental disorders, history of sexual/physical abuse • Social support

14. PTSD- Types of Trauma • Rape • Anticipatory phase, impact phase, posttraumatic recoil phase, and reconstitution phase • Military combat

15. Treatment • Immediate treatment (if possible) • Stress innoculation training • provide information about the stressful situation • rehearse adaptive self-statements • practice self-statements while expose to various stressors • Exposure

16. Anxiety Disorders and OCD

18. Who is afraid of ? • small insect • animal, reptile • speaking to a large audience • speaking in front of a small group of familiar people • meeting new people • attending social gatherings

19. Anxiety as a Normal and an Abnormal Response • Some amount of anxiety is “normal” and is associated with optimal levels of functioning. • Only when anxiety begins to interfere with social or occupational functioning is it considered “abnormal.”

20. Bell Curve

21. The Fear and Anxiety Response Patterns • Fear • Panic • Anxiety • Anxiety Disorder

22. Phobia Disorders • Phobias • Specific phobias • Social phobia • Agoraphobia

23. Specific Phobias

24. Specific Phobias • Psychosocial causal factors • Genetic and temperamental causal factors • Preparedness and the nonrandom distribution of fears and phobias • Treating specific phobias

25. Social Phobia • General characteristics Fear of being in social situations in which one will be embarrassed or humiliated

26. Social Phobia • Interaction of psychosocial and biological causal factors • Social phobias as learned behavior • Social fears and phobias in an evolutionary context • Preparedness and social phobia

27. Social Phobia • Interaction of psychosocial and biological causal factors • Genetic and temperamental factors • Perceptions of uncontrollability • Cognitive variables

28. Panic Disorder With and Without Agoraphobia • Panic disorder • Panic versus anxiety • Agoraphobia • Agoraphobia without panic

29. Panic Disorder • Prevalence and age of onset • Comorbidity with other disorders • Biological causal factors • The role of Norepinephrine and Serotonin

30. Panic and the Brain

31. Panic Disorder • Genetic factors • Cognitive and behavioral causal factors • Interoceptive fears

32. Panic Disorder: The Cognitive Theory of Panic

33. Panic Disorder: The Cognitive Theory of Panic • Perceived control and safety • Anxiety sensitivity as a vulnerability factor for panic • Safety behaviors and the persistence of panic • Cognitive biases and the maintenance of panic

34. Treating Panic Disorder and Agoraphobia • Medications • Behavioral and cognitive-behavioral treatments

35. Generalized Anxiety Disorder • General characteristics • Prevalence and age of onset • Comorbidity with other disorders

36. Generalized Anxiety Disorder:Psychosocial Causal Factors • The psychoanalytic viewpoint • Classical conditioning to many stimuli • The role of unpredictable and uncontrollable events • A sense of mastery: immunizing against anxiety

37. Generalized Anxiety Disorder:Biological Causal Factors • Genetic factors • A functional deficiency of GABA • Neurobiological differences between anxiety and panic

38. Obsessive-Compulsive Disorder • Obsessions- repetitive unwanted ideas that the person recognizes are irrational • Compulsions- repetitive, often ritualized behavior whose behavior serves to diminish anxiety caused by obsessions

39. Obsessive-Compulsive Disorder • Prevalence and age of onset • Characteristics of OCD • Types of compulsions • Comorbidity with other disorders

40. Obsessive-Compulsive Disorder:Psychosocial Causal Factors • Psychoanalytic viewpoint • Behavioral viewpoint • The role of memory • Attempting to suppress obsessive thoughts

41. Obsessive-Compulsive Disorder:Biological Causal Factors • Genetic influences • Abnormalities in brain function • The role of serotonin

42. Somatoform and Dissociative Disorders I. Somatoform Disorders

43. A. Sick Role • Have you ever “played sick” in order to get out of something?How did that work out (did you get what you wanted)? • Sick  attention (friends, family, medical) = secondary gains • Likely link between secondary gains and somatoform disorders • Some medical condition may actually exist

44. B. Somatization Disorder • Historical perspective • In the medical/clinical nomenclature since the mid-1600’s • Known as “Hysteria,” “hypochondriasis,” and “melancholia” until 1800’s when mental disorders were differentiated • Briquet’s syndrome, named for the French physician who initially defined it in 1859 • Term “somatization disorder” was first used in DSM-III (1980)

45. B. Somatization (cont.) • DSM-IV criteria (p. 174) A. History of many physical complaints beginning before age 30 occurring over several years resulting in treatment being sought or significant impairment in functioning

46. 2. DSM-IV criteria (cont.) B. Each of the following met at some point during disorder: 1) 4 pain symptoms 2) 2 gastrointestinal symptoms 3) 1 sexual symptom 4) 1 pseudoneurological symptom

47. 2. DSM-IV criteria (cont.) C. Either: 1) symptoms in Criterion B cannot be fully explained by a known GMC or 2) when a GMC does exist, the symptoms in Criterion B are in excess of what would be expected based on medical facts D. Symptoms not intentionally feigned or produced

48. B. Somatization (cont.) • Additional descriptive information • Report of symptoms usually colorful or exaggerated; factual info usually lacking • Lab findings do not support somatic complaints • Treatment sought from several doctors at once  hazardous mix of treatments

49. 3. Additional info (cont.) • Primary relationships are with doctors; personal relationships usually have problems • Often seem indifferent about what symptoms represent • Concerned with individual symptoms, not what symptoms might indicate in terms of a disease • Physical symptoms become part of their identity (ego syntonic)

50. B. Somatization (cont.) • Statistics and course • Lifetime prevalence: • 0.2 – 2% in women • less than 0.2% in men • Rates affected by rater, method of assessment, and demographic variables: • Non-physicians diagnose it less frequently • In primary medical care settings, rate is 4.4 – 20% • Typical demographic is lower SES unmarried woman