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Psychological Disorders. PSYCHOLOGY Mr. Noble 2008-09

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psychological disorders

Psychological Disorders

PSYCHOLOGY

Mr. Noble

2008-09

A special thanks to my former student teacher--Ms. Sharon Mohr--for her diligent research, insightful professional expertise, and valuable thoughtful effort in compiling much of the information included in this overview of Psychological Disorders.

defining abnormality
Defining Abnormality
  • Difficult to define…
  • 3 Criteria…
    • Deviance
    • Distress
    • Disability/Maladaptive Behavior
  • Symptom/Behavior Continuum:

_----_________________ normal range__ __________________+++

Abnormal Abnormal

ancient perspective
Ancient Perspective
  • Perceived Causes
    • movements of sun or moon
      • lunacy- full moon
    • evil spirits
  • Ancient Treatments
    • exorcism, caged like animals, beaten, burned, mutilated, blood replaced with animal’s blood
bio psycho social model

Biological

(chemistry, brain)

Psychological

( learned helplessness,

negative perceptions

and memories)

Sociocultural

(Societal expectations,

definition of normality

and disorder)

Bio-psycho-social Model
  • assumes that biological, sociocultural, and psychological factors combine and interact to produce psychological disorders
medical model
Medical Model
  • Diagnosis
    • Label for a set of symptoms
  • Prognosis
    • Prediction or forecast for the course of a D/O
  • Etiology
    • Suspected cause of a disorder
classifying disorders
Classifying Disorders
  • DSM-IV-TR
    • Diagnostic and Statistical Manual of Mental Disorders, 4th edition, Text Revision
    • Published by the American Psychiatric Association
    • 2000…(most recent update 2004)
    • Next major revision (DSM-V) anticipated for 2011.
  • Provides for reliable classification and description of all mental illnesses
  • Allows for better communication
dsm s multi axial diagnosis
DSM’s Multi-axial Diagnosis
  • Axis I Major Clinical Disorders
  • Axis II Mental Retardation & Personality Disorders
  • Axis III General Medical Conditions
  • Axis IV Psychosocial/Environmental Stressors
  • Axis V Global Assessment of Functioning
    • # between 1 and 100
    • Current and Highest in past year
labeling issues
Labeling Issues
  • Reasons to Label/Diagnose:
    • Needed for communication
    • Guide treatment
    • Insurance reimbursement
  • Arguments against Labeling:
    • Creates a stigma
    • Creates a self-fulfilling prophecy
    • Fail to see the person behind the disorder
major classes of disorders
Major Classes of Disorders
  • Anxiety Disorders
  • Mood Disorders
  • Somatoform Disorders
  • Dissociative Disorders
  • Schizophrenia
  • Substance Use Disorders
  • Other Axis I Disorders
  • Personality Disorders (Axis II)
i anxiety disorders
I. Anxiety Disorders
  • Characterized by generalized apprehension, worry, and a variety of physical symptoms
  • Generalized Anxiety Disorder
  • Phobias
  • Panic Disorder
  • Obsessive-Compulsive Disorder
  • Post-traumatic Stress Disorder
generalized anxiety disorder
Generalized Anxiety Disorder
  • Experiencing a continuous, generalized feeling of anxiety (reaction to vague or imagined dangers) – 6 months or more
  • Anxiety in many different areas of life
  • Accompanied by physical symptoms…

muscle tension, trouble sleeping, irritability, lack of concentration, headaches, fatigue, inability to relax, twitching/trembling, etc.

phobias
Specific Phobia

Severe anxiety is focused on a specific object or situation

Examples:

Enclosed spaces

Snakes

Spiders

Heights

Flying

Social Phobia

Fear of embarrassing oneself in a social situation

Speaking, eating, using bathroom in public

Agoraphobia

“fear of the marketplace”

Associated with panic disorder

Phobias
phobias http www phobialist com reverse html

100

90

80

70

60

50

40

30

20

10

0

Percentage

of people

surveyed

Snakes

Being

in high,

exposed

places

Mice

Flying

on an

airplane

Being

closed in,

in a

small

place

Spiders

and

insects

Thunder

and

lightning

Being

alone

In a house

at night

Dogs

Driving

a car

Being

In a

crowd

of people

Cats

Afraid of it

Bothers slightly

Not at all afraid of it

PHOBIAS http://www.phobialist.com/reverse.html
  • Common and uncommon phobias
phobias treatment
PHOBIAS Treatment

Exposure Treatment

Flooding

Counter-Conditioning

Systematic Desensitization (1) training the patient to physically relax (2) establishing an anxiety hierarchy of the stimuli (3) counter-conditioning relaxation responding to ea. feared stimulus

Biofeedback

Modeling

panic disorder

“Nothing is so much to be feared as Fear”

---Henry David Thoreau

Panic Disorder
  • Frequent Panic Attacks or fear of them:
    • Sudden and unexplainable attacks of

intense fear

    • Come on without warning
    • Not associated with a stimulus
    • Individual fears that he/she is about to die
    • Physical symptoms…choking, tightness in chest, difficulty breathing, nausea, dizziness
    • Commonly occurs with Agoraphobia
obsessive compulsive disorder
OBSESSIONS

Intrusive and uncontrollable thoughts

Contamination, safety, etc.

COMPULSIONS

Ritualistic and purposeless actions

Cleaning, washing, checking, etc.

O and C are usually related… compulsions help to decrease the anxiety caused by the obsession

This pattern begins to interfere with functioning

Obsessive-Compulsive Disorder
slide17

Common Obsessions and Compulsions Among

People With Obsessive-Compulsive Disorder

Thought or Behavior

Percentage*

Reporting Symptom

Obsessions (repetitive thoughts)

Concern with dirt, germs, or toxins 40

Something terrible happening (fire, death, illness) 24

Symmetry order, or exactness 17

Compulsions (repetitive behaviors)

Excessive hand washing, bathing, tooth brushing, 85

or grooming

Repeating rituals (in/out of a door, 51

up/down from a chair)

Checking doors, locks, appliances, 46

car brake, homework

OCD
post traumatic stress disorder
Post-traumatic Stress Disorder
  • Common among veterans of combat, survivors of accidents and disasters, victims of crimes, etc.
  • Feel long-lasting after-effects of trauma
  • Flashbacks, nightmares, insomnia, mood symptoms, stimulus generalization
  • Symptoms last more than 1 month… up to years later
ii mood disorders
II. Mood Disorders
  • Mental disorders characterized by disturbances of mood that are intense and persistent enough to be maladaptive
  • Normal range of mood…
    • Major Depressive Disorder
    • Bipolar Disorder
major depressive disorder
Major Depressive Disorder
  • Clinical depression/Major Depression
  • Unipolar depression
  • Single-episode or recurrent episodes
  • Symptoms must occur for at least 2 weeks
  • Subtypes:
    • Post-partum onset
    • S.A.D.
  • Secondary symptoms…
depression symptoms
Depression…symptoms

Sleep disturbance

Interest 

Guilt/worthlessness

Energy  = fatigue

Concentration 

Appetite disturbance/weight gain/loss

Psychomotor agitation/retardation

Suicidal/thoughts of death

causes of depression
Causes of Depression
  • Genetic Predisposition
    • + stressful life events
  • Neurotransmitters
    • Serotonin
    • Norepinephrine
  • Cognitive Theories
    • Beck & Seligman
  • Behavioral Theories
bipolar disorder
Bipolar Disorder
  • Previously known as Manic-Depression
  • Experience both manic and depressive episodes
    • Mania = emotional state characterized by intense and unrealistic feelings of excitement and euphoria, along with impulsivity
  • Cycles…not mood swings
  • High rate of suicide
mood disorders bipolar

Depressed state

Manic state

Depressed state

Mood Disorders-Bipolar
  • PET scans show that brain energy consumption rises and falls with emotional swings
mood disorders suicide
Mood Disorders & Suicide
  • Not all people who commit suicide are depressed; Not all depressed people commit suicide
  • Associated with mood disorders, especially bipolar disorder (also schizophrenia)
  • Warning Signs…
  • Risk factors…
  • Prevention…
slide27

SUICIDE:Male v. Female

  • Males
  • Suicide is the eighth leading cause of death for all U.S. men.
  • Males are four times more likely to die from suicide than females.
  • Suicide rates are highest among Whites and second highest among American Indian and Native Alaskan men.
  • Of the 24,672 suicide deaths reported among men in 2001, 60% involved the use of a firearm.
  • Females
  • Women report attempting suicide during their lifetime about three times as often as men.
slide28

SUICIDE:Youth

  • Overall rate of suicide among youth has declined slowly since ‘92.
  • However, rates remain unacceptably high.
  • Adolescents and young adults often experience stress, confusion, and depression from situations occurring in their families, schools, and communities.
  • Such feelings can overwhelm young people and lead them to consider suicide as a “solution.”
  • Few schools and communities have suicide prevention plans that include screening, referral & crisis intervention programs for youth.
slide29

SUICIDE:Youth

  • Suicide is the third leading cause of death among young people ages 15 to 24.
  • Of the total number of suicides among ages 15 to 24 in 2001, 86% were male and 14% were female.
  • American Indian and Alaskan Natives have the highest rate of suicide in the 15 to 24 age group.
  • In 2001, firearms were used in 54% of youth suicides.
slide31

SUICIDE:Risk Factors

The first step in preventing suicide is to identify and understand the risk factors.

  • Previous suicide attempt(s)
  • History of mental disorders, particularly depression
  • History of alcohol and substance abuse
  • Family history of suicide
  • Family history of child maltreatment
  • Feelings of hopelessness
  • Impulsive or aggressive tendencies
  • Barriers to accessing mental health treatment
slide32

SUICIDE:Risk Factors

The first step in preventing suicide is to identify and understand the risk factors.

  • Loss (relational, social, work or financial)
  • Physical illness
  • Easy access to lethal methods
  • Unwillingness to seek help due to stigma
  • Local epidemics of suicide
  • Isolation - feeling cut off from other people
slide33

SUICIDE:Protective Factors

Protective factors buffer people from the risks associated with suicide. A number of protective factors have been identified:

  • Effective clinical care
  • Easy access to clinical interventions & support
  • Family and community support
  • Medical & mental health care relationships
  • Problem solving, conflict resolution skills
  • Cultural & religious beliefs/support
iii somatoform disorders
III. Somatoform Disorders
  • Also know as Hysteria (Freud)
  • Conditions involving physical complaints or disabilities that occur without physical pathology
  • NOT psychosomatic disorders…
    • Conversion Disorder
    • Hypochondriasis
conversion disorder
Conversion Disorder
  • Conversion of emotional difficulties into the persistent loss of a physiological function
  • Paralysis, loss of feeling, exceptional sensitivity, mutism, blindness, deafness
  • Not faking a physical problem
  • Cannot be explained physically
hypochondriasis somatization disorders
Hypochondriasis

Preoccupation with fear that he/she has a serious disease

Based on the misinterpretation of bodily symptoms

Mountain out of a molehill

No evidence of illness

Somatization Disorder

History of diverse physical complaints of all varieties (all body systems)

Focus on numerous symptoms

Many trips to doctor, many medications, no root cause found

Hypochondriasis & Somatization Disorders
iv dissociative disorders
IV. Dissociative Disorders
  • Dissociation…the human mind’s capacity to mediate complex mental activity in channels split off from or independent of conscious awareness
  • A way of managing anxiety and stress…
  • Psychogenic/Dissociative Amnesia & Fugue
  • Dissociative Identity Disorder
amnesia fugue
PSYCHOGENIC AMNESIA

Inability to recall certain personal information, which is still know at the unconscious level

Loss in episodic memory, not procedural or semantic

PSYCHOGENIC FUGUE

Loss of memory accompanied by an actual flight from one’s present life situation to a new environment

May take on a new identity

Amnesia & Fugue
dissociative identity disorder
Dissociative Identity Disorder
  • Previously known asMultiple Personality Disorder
  • Individual manifests at least two or more distinct systems of identity
  • Host personality + Alter identities (15)
  • Associated with childhood abuse
  • Rare disorder; Popular in media
  • Can be faked or influenced by therapist
v schizophrenia
V. Schizophrenia
  • Characterized by confused and disordered thoughts and perceptions
  • Most debilitating of the mental disorders; Deterioration of adaptive behavior
  • Subtypes:
    • Paranoid
    • Disorganized
    • Catatonic
    • Undifferentiated
schizophrenia symptoms
Schizophrenia…symptoms

Bizarre behaviors (catatonia, others)

Affect (inappropriate, flat)

Delusions

Speech (disorganized, incoherent)

Hallucinations

Inability to care for self or function

Negative symptoms

positive vs negative sx
Positive vs. Negative Sx
  • POSITIVE SYMPTOMS
    • Presence of something abnormal
    • Examples:
  • NEGATIVE SYMPTOMS
    • Absence of something normal
    • Examples:
schizophrenia
Schizophrenia…
  • DELUSIONS
    • False beliefs maintained in the face of contrary evidence
    • Types: Grandeur Identity

Persecution Reference

  • HALLUCINATIONS
    • Sensations in the absence of external stimuli
    • Types: visual, auditory, tactile, olfactory, gustatory
causes of schizophrenia
Causes of Schizophrenia
  • Genetic Predisposition
    • Twin study evidence
  • Neurotransmitters
    • Dopamine hypothesis
  • Brain Structure & Function
  • Family & Interactions
    • Double-bind theory
    • Schizophrenogenic mother
vi substance use disorders
VI. Substance Use Disorders
  • Substance Abuse
  • Substance Dependence
    • Psychological dependence + Addiction
    • Alcoholism = Alcohol Dependence
  • Important terms…
    • Tolerance
    • Withdrawal
vii other axis i disorders
VII. Other Axis I Disorders
  • Eating Disorders
  • Sleep Disorders
  • Disorders of childhood and adolescence
    • Autism, ADHD, Tourette’s, Conduct Disorder
  • Sexual and Gender Identity Disorders
  • Cognitive Disorders
  • Impulse Control Disorders
  • Adjustment Disorders
viii personality disorders
VIII. Personality Disorders
  • Diagnosed on Axis II
  • Stem from the gradual development of inflexible and distorted personality and behavioral patterns that result in persistently maladaptive ways of relating to the world
  • Ego-syntonic…not a problem for the person
    • A problem for others
  • Resistant to treatment (only behavioral)
  • FOCUSAntisocial, Narcissistic, OCPD
slide48

Symptoms of Obsessive Compulsive Personality Disorder

  • OCPD symptoms tend to appear early in adulthood and are defined by inflexibility, close adherence to rules, anxiety when rules are transgressed, and unrealistic perfectionism. A person with obsessive compulsive personality disorder exhibits several of the following symptoms:
  • abnormal preoccupation with lists, rules, and minor details
  • excessive devotion to work, to the detriment of social and family activities
  • miserliness or a lack of generosity
  • perfectionism that interferes with task completion, as performance is never good enough
  • refusal to throw anything away (pack-rat mentality)
  • rigid and inflexible attitude towards morals or ethical code
  • unwilling to let others perform tasks, fearing the loss of responsibility
  • upset and off-balance when rules or routines disrupted.
psychopathology the law
Psychopathology & The Law
  • Competence to Stand Trial
    • Can individual participate in own defense at time of trial?
  • Involuntary Civil Commitment
    • Should individual be hospitalized against their will due to imminent danger?
    • Suicidal or homicidal
    • Decided by doctor, then court; need evidence
more legal issues state level
More Legal Issues…State-level
  • Insanity Plea
    • Should individual not be held accountable due to their mental state at the time of the crime?
      • Could not determine right from wrong
    • Determined by judge before actual trial
    • Difficult to prove, but prevalent in media
    • Sent for treatment, then released

*Insanity is a LEGAL term…!

more legal issues state level51
More Legal Issues…State-level
  • Guilty but Mentally Ill
    • Alternative to insanity plea in some states
    • Adopted by Pennsylvania…
    • 1st trial determines guilt or innocence
    • 2nd trial determines sanity or insanity
    • Sent for treatment, then to prison to complete sentence…get treatment as well as punishment
slide52

TYPES OF PSYCHOTHERAPY — A number of types of psychotherapy are used to treat psychological disorders:

  • Cognitive therapy identifies habitual ways in which patients distort information (e.g. automatic thoughts) and teaches patients to identify, evaluate, and respond to their dysfunctional thoughts and beliefs, using a variety of techniques to change thinking, mood, and behavior. Cognitive therapy is a structured, goal oriented, problem focused, and time limited intervention.
slide53

TYPES OF PSYCHOTHERAPY

  • Behavioral therapy attempts to alter behavior by systematically changing the environment that produces the behavior. Behavioral changes are believed to lead to changes in thoughts and emotions.
  • Exposure-based behavioral treatments utilize gradual, systematic, repeated exposure to the feared object or situation to allow patients with anxiety disorders to become desensitized to the feared stimulus.
slide54

TYPES OF PSYCHOTHERAPY

  • Cognitive Behavioral therapy (CBT) combines principles of both behavioral and cognitive therapy, focusing simultaneously on the environment, behavior, and cognition. Cognitive behavioral therapy is also structured, goal directed, problem focused. Patients learn how their thoughts contribute to symptoms of their disorder and how to change these thoughts. Increased cognitive awareness is combined with specific behavioral techniques.
slide55

TYPES OF PSYCHOTHERAPY

  • Problem Solving therapy, a short-term, cognitive behavioral intervention, teaches a systematic method for solving current and future problems. Patients acquire new skills for successfully resolving interpersonal difficulties. These skills include the following sequential steps: 1) Problem definition; 2) Goal setting; 3) Generating, choosing, and implementing solutions; and 4) Evaluating outcomes.
slide56

TYPES OF PSYCHOTHERAPY

  • Interpersonal therapy addresses issues such as grief, role transitions, interpersonal role disputes, and interpersonal deficits as they relate to the patient's current symptoms.
  • Family therapy attempts to correct distorted communications and relationships as a means of helping the entire family, including the identified patient. In patients with serious mental illness, such as schizophrenia, family therapy helps family members learn about the disorder, solve problems, and cope more constructively with the patient's illness.
slide57

TYPES OF PSYCHOTHERAPY

  • Psychoeducation provides patients with information about their diagnosis, its treatment, how to recognize signs of relapse, relapse prevention, and strategies to cope with the reality of prolonged emotional or behavioral difficulties.
  • The goal of psychoeducation is to reduce distress, confusion, and anxiety within the patient and/or the patient's family to facilitate treatment compliance and reduce the risk of relapse.
  • Psychoeducation is often particularly helpful for patients and the families of patients with chronic, severe psychiatric disorders such as schizophrenia and bipolar disorder.