Today’s class…

1. Psych 120General PsychologyChristopher GadeOffice: 1030AOffice hours: MW 4:30-5:30Email: gadecj@gmail.comClass MW 1:30-4:30 Room 2240

2. Today’s class… • In the final three lecture sections of the course, we’ll be discussing three major disorder groups. • Anxiety disorders • Mood disorders • Schizophrenia

3. Anxiety Disorders • Anxiety disorders involve an intense experience of anxiety and a series of efforts to deal with it. • Four major categories of anxiety disorders: • Generalized Anxiety Disorder • Panic Disorder • Phobias • Obsessive Compulsive Disorder

4. Generalized Anxiety Disorder • Is found in 5-6% of the population. • 11, 14, 27 • Involves a pervasive and free floating anxiety. • Affected people feel continuously tense and jittery, worried, and suffer from sleeplessness. • Antidepressant medication & relaxation training have been shown to be effective treatments.

5. Panic Disorder • 1-3% of the population are diagnosed with this disorder at some time in their life. • 02, 25 • Identified through the occurrence of frequent panic attacks. • Panic attacks: minutes-long episodes of intense fear that something awful is going to happen. These attacks feature… • heart palpitations • shortness of breath • choking sensations • trembling • Repeated incidences lead to fear of ‘panic attack’, and thus a panic disorder and associated phobias, i.e. agoraphobia. • Antidepressants and behavior therapy are sometimes beneficial treatments. • Age and time also are associated with a decrease in panic disorder occurrence rates.

6. Phobias • Afflicts 11% of the population during their lifetime and 5-6% at any time. • 6, 38, 28, 15, 30 • Fears are identified as a phobia when anxiety or irrational fear of a particular object or situation are extreme enough to interfere with everyday living. • There is evidence for a genetic link in the predisposition for developing phobias, (some life experience usually must occur to cause the phobia). • Behavioral therapy that have been shown to ameliorate phobias . • systematic desensitization and flooding • Pharmacological therapy for phobias include tranquilizers and antidepressant drugs.

7. Phobias (cont) • Some theories for the cause of phobias: • We might be evolutionarily ‘primed’ for fear of some and situations • Snakes versus electricity • Our fears of certain objects or situations are based on amount of safe vs. scary exposures. • Airplanes versus automobiles • people are more prone to develop phobias of objects or situations that they cannot predict or control • Shark attacks

8. Obsessive Compulsive Disorder • Found in 2-3% of the population • 07 • Repetitive, irresistible acts (compulsions) performed to alleviate an ongoing anxious stream of thought (obsessions) with such persistence that they interfere with normal life activities. • Typically found in average, hard working perfectionists. • Associated with guilt as much as anxiety (trying to suppress shameful thoughts/desires: cleaning compulsion, checking compulsion). • Some evidence for genetic contribution to OCD, especially in patients that develop OCD before 18 yrs. • Most will improve with or without treatment over time. • Exposure therapy is often used: present the OCD person with a situation which facilitates the obsessions and prevent them from performing the compulsions to demonstrate that nothing catastrophic will occur.

9. Overview • All of the different disorders listed in lecture today are all classified under the anxiety disorders category in the DSM. • Each has its own prevalence, defining characteristics, and causes/solutions. • However, when looking at these disorders, they are all considered very similar by most clinical psychologists.

11. Mood Disorders • Mood disorders all involve long-term problems with basic emotions. All but one of the most prevalent mood disorders are associated with a negative, unpleasant mood. • There are a number of mood disorders that exist, with one being the most prevalent and well known. • Depression • Seasonal Affective Disorder • Dysthymia • Bipolar Disorder

12. Depression • 5% of population is diagnosed in a given year, 10-20% in their lifetime • 17, 24, 12, 16, 7, 2, 43, 27, 33, 26 • Multiple symptoms associated with the diagnosis of this disorder • feeling little interest in anything (including food and sex) • little pleasure • little motivation to be productive all day long for an extended period of time (at least 2 weeks). • Also associated with • A feeling of powerlessness, guilt and worthlessness • Suicidal ideation and attempts • sleep abnormalities

13. Depression (cont.) • Depression is a family and genetic linked disorder • Life events contribute to the emergence of depression • Women are diagnosed with depression about twice as much • Cognitions are associated with depression: • pessimistic vs. optimistic • internal vs. external • global vs. singular • stable vs. dynamic • Treatments for depression: • regular sleep and exercise for mild to moderate depression • ECT (no stats for major depression) • placebo • drug interventions • psychotherapies • Few people remain permanently depressed

15. Seasonal Affective Disorder and Dysthymia • Seasonal Affective Disorder • Associated with the change of seasons • Symptoms are similar to those of depression, but to a milder extent • Light therapy is a popular treatment for this disorder • Prevalence of disorder depends upon location • approx 1% of Floridians • Approx 9-10% of Minnesotans • 49, 18 • Dysthymia • Symptoms are similar to those of depression. • Much less severe symptoms • Lasts much longer than depression (2 years before diagnosis) • Not considered traumatic at any given time, but can be very debilitating through its long-term effects • 29, 33

17. Bipolar Disorder • AKA manic depressive disorder • Found in only 1% of the population • 22 • involves a person alternating between feeling depressed and feeing manic: constantly active and uninhibited, excited or irritable. • Two forms of bipolar disorder • Bipolar Type I • Bipolar Type II (hypomania) • Twin studies suggest a genetic component to Bipolar Disorder • Treatments include Lithium and anticonvulsants

18. Overview • As in the last class, all of the different disorders listed in lecture today are all classified under the same disorders category in the DSM (affective disorders). • Each again has its own prevalence, defining characteristics, and causes/solutions. • But… again, when looking at these disorders, they are all considered very similar by most clinical psychologists.

20. Schizophrenia • What it is NOT: multiple personality disorder, sociopathy, or antisocial personality disorder. • What it is: a severe disconnect with reality with many cognitive and emotional symptoms. • Affects about 1% of the population • 16 • Almost identical incidence in men & women (7:5 ratio has been found in recent studies) • Onset is usually sometime between 16 and 25 yrs old (later for women)

21. Diagnosis of Schizophrenia • The DSM-IV diagnosis of schizophrenia requires that the person exhibit a complete deterioration of daily activities along with at least two of the following symptoms: • Hallucinations • Delusions or thought disorders • Incoherent speech • Grossly disorganized behavior • Loss of normal emotional responses and social behaviors • Note: If the hallucinations or delusions are severe enough, no other symptoms are required in the diagnosis of this disorder.

22. More on the symptoms… • Schizophrenia symptoms are categorized into two groups • Positive Symptoms: behaviors that are present, or added to the persons repertoire of behavior as a result of the schizophrenia. • Negative Symptoms: behaviors that are diminished, or absent from the persons repertoire of behavior as a result of the schizophrenia.

23. Positive Symptoms • Hallucinations: perceiving things that are not there (auditory and visual). • Auditory hallucinations are much more common that visual ones. • Almost all of us occasionally have auditory (any maybe visual) hallucinations. Schizophrenics are distinguished by the frequency and complexity of these hallucinations. • Delusions: very rigid false or unfounded beliefs. • persecution: a belief that others (groups and individuals) are conspiring against or persecuting the individual (e.g. “they’re all after me”) • grandiose: a belief in unusual importance (e.g. pregnancy ‘flicks’) • reference: a tendency to interpret all messages as if they were meant for oneself (there are codes for me in the newspaper headlines) • bizarre: random delusions that don’t fall under any of the previous categories (e.g. some of my vital organs are missing)

24. Negative Symptoms • Flat affect: blunted expression of emotion, e.g. mask-like face, flat voice, poor eye contact. • Anhedonia: Diminished ability to experience pleasure, e.g. report little enjoyment in life, seek out few enjoyable activities. • Social Withdrawal • Inattentiveness, thought blocking (a particularly abrupt or complete interruption of thought).

25. Disorganized Symptoms • Disorganized speech: • severe tangentiality • loose associations • derailment of thought • Disorganized behavior: • catatonic behavior • unusual postures

26. Theorized Causes • Genetic • Twin studies suggest a genetic component in susceptibility for schizophrenia • No single gene has been linked to schizophrenia • Brain abnormality/malformation • the hippocampus and parts of the cerebral cortex are a little smaller than normal, the cerebral ventricles are larger than normal, the neurons are smaller there are fewer synapses in the prefrontal cortex. • Is this a causal or correlational relationship? • The neurodevelopmental hypothesis • schizophrenia is the result of nervous system impairments that develop before and/or around the time of birth. • Caused partially though genetics, but also through environmental influences: • poor prenatal care • difficult pregnancy and labor • mother’s exposure to influenza virus.

29. Treatments • Medication: Antipsychotic or neuroleptic drugs. • These all relieve symptoms for at least a little while. • Some block dopamine synapses in the brain, others effect glutamate concentration. • Most in the past produced unpleasant side effects: tardivedyskenesia. • Hospitalization: useful for only acute episodes. • Cognitive Behavioral Therapy (CBT): • Hallucinations: help patients perceive distinctions between internal/external • Delusions: treat self-esteem or other psychological issues • Flat affect: increase social skills • Anhedonia: increase activities.

30. Treatment Success • Most treatments provide temporary success almost immediately. • Over the long run, success rates wane greatly. • Success rates are highly associated with the intensity of the symptoms pre-treatment, and the time between onset and treatment of the disorder. • The Rule of thirds for medication. • Acute and sudden onset: good response to medication • Middle: could be either sudden or acute, mixed response to medication • Chronic: slow, insidious onset, poor response to medication

32. THE END • This marks the end of the lectures for this class. Come on time on Wednesday for the last exam. • Good luck in your studies, and thanks for spending some time with me this summer.