One set of biological theories focuses on abnormalities in the levels of particular neurotransmitters . According to one such view, people with panic disorder have an excess of norepinephrine or gamma-aminobutyric acid (GABA) in the brain. According to anxiety sensitivity theory , people with panic disorder tend to interpret cognitive and somatic manifestations of stress and anxiety in a catastrophic manner causing the individual to hyperventilate. If this increase in the rate of breathing fails to lower blood levels of carbon dioxide, the individual is thrown into a panic attack (Klein, 1993). Conditioned fear reactions : The individual associates certain bodily sensations with memories of the last panic attack, causing a full-blown panic attack to develop even before measurable biological changes have occurred.
The most effective antianxiety medications are benzodiazepines . Because these medications often lose their therapeutic efficacy and lead to physiological or psychological dependence, clinicians have sought alternatives, including antidepressants and serotonin reuptake inhibitors such as fluoxetine (Prozac). Relaxation training : The client learns to systematically alternate tensing and relaxing muscles all over the body. Panic control therapy (PCT) consists of cognitive restructuring, the development of an awareness of bodily cues associated with panic attacks and breathing retraining.
People who are diagnosed as having generalized anxiety disorder have a number of unrealistic worries that spread to various spheres of life. From a biological perspective, it is suggested that people with generalized anxiety disorder have a biological abnormality similar to that proposed to account for other anxiety disorders involving abnormalities of GABA, serotogenic, and nonadrenergenic systems. Treatment from this perspective emphasizes medication. The cognitive-behavioral approach to generalized anxiety disorder emphasizes the unrealistic nature of these worries and regards the disorder as a vicious cycle that feeds on itself. Cognitive-behavioral treatment approaches recommend breaking the negative cycle of worry by teaching individuals techniques that allow them to feel they control the worrying.
Everyone has fears about or unpleasant responses to certain objects, situations, or creatures. Such responses of discomfort or dislike, called aversions , are common and are not considered phobias. However, if a person’s response to one of these experiences is far out of proportion to the danger of threat posed by the stimulus, the person is considered to have a phobia.
Some phobias -- such as animal phobias, blood injury phobias, claustrophobia, and dental phobias -- can be traced back to childhood. The primary biological perspectives on specific phobias involve the notion that humans are essentially preprogrammed to fear certain situations or stimuli that could threaten our survival.
Systematic desensitization rests on the premise that an individual can best overcome maladaptive anxiety by approaching feared stimuli gradually, while in a relaxed state. In a behavioral technique called flooding , the client is totally immersed in the sensation of anxiety. In imaginal flooding , the client listens to someone read several vivid descriptions. In the graduated exposure method, clients initially confront situations that cause only minor anxiety and then gradually progress toward those that cause greater anxiety. In thought stopping , the individual learns to stop anxiety-provoking thoughts.
Unlike obsessions, which cause anxiety, compulsions are carried out in an effort to reduce anxiety or stress.
People with OCD are seen as having thoughts and actions that they literally cannot inhibit, as though the brain structures involved in this process are, in essence, “working overtime” to try to control them.
A traumatic experience is a disastrous or extremely painful event that has severe psychological and physiological effects. Aftereffects of the traumatic event can include flashbacks, nightmares, and intrusive thoughts that alternate with the individual's attempts to deny that the event ever took place.
Post-traumatic stress disorder (PTSD) is appropriate when the symptoms persist for more than a month. The symptoms of PSTD seem to fall into two related clusters. The first, called “ intrusions and avoidance ,” includes intrusive thoughts, recurrent dreams, flashbacks, hyperactivity to cues of the trauma, and the avoidance of thoughts or reminders. The second cluster, “ hyperarousal and numbing ,” includes symptoms that involve detachment, a loss of interest in everyday activities, sleep disturbance, irritability, and a sense of foreshortened future.
It seems that even the structure of the brain can change as a result of trauma; for example, researchers have noted that women with PTSD who had been victimized in childhood show brain changed similar to those of combat veterans—namely, a reduction in the size of the hippocampus. According to classical behavioral approaches, it is assumed that the person with PTSD has acquired a conditioned fear to the stimuli that were present at the time of the trauma. In assessing the role of sociocultural factors in the determination of PSTD, investigators have been particularly interested in the ways that disadvantaged economic settings may set the stage for increased vulnerability.
People can experience a mood disorder in the form of extreme depression, excessive elation, or a combination of these emotional states. The primary characteristic of depressive disorders is dysphoria . Bipolar disorder alternates between dysphoria and euphoria .
People whose depressive episodes have melancholic features lose interest in most activities or find it difficult to react to events in their lives that would customarily bring pleasure. Episodes showing a seasonal pattern develop at about the same time each year, usually for about 2 months during the fall or winter, then return to normal functioning.
Bipolar disorder involves an intense and very disruptive experience of extreme elation, or euphoria , called a manic episode , which is characterized by abnormally heightened levels of thinking, behavior, and emotionality that cause significant impairment.
A mixed episode consists of symptoms of both a manic episode and a major depressive episode which alternate rapidly.
F irst discovered in animal research. Martin Seligman and colleagues found that when dogs were unable to escape electrical shocks, they simply gave up trying, even when escape was later possible. People who try without success become conditioned to failure and stop trying Attributions (explanations people make of what happens to them) play a cognitive role Internal attributions (“all my fault”). External attributions (outside circumstances). Internal attributions lead to globalization of negative experiences.
Overgeneralizing: Believing that if something is true in one case, it applies to any case that is even similar. Selective abstraction: The only events that the person takes seriously are those that represent bad things like failure. Excessive responsibility: Feeling responsible for all bad things that happen to them or others to whom they are close. Assuming temporal causality: Thinking that if something has been true in the past, it will always be true. Catastrophizing: Always thinking the worst and being certain that it will happen. Dichotomous thinking: Seeing everything as either one extreme or another, rather than as mixed or in between. Other cognitive distortions include assuming temporal causality (thinking if something has been true in the past, it will always be true), and making excessive self-references (seeing themselves as the center of everyone’s attention, and thinking they can all see when the individual makes mistakes).
Didactic work: The therapist explains the theory to the client and teaches the client depression results from faulty thinking. Then cognitive restructuring can being.
DSM-IV disorders associated with suicide include mood disorders, schizophrenia, anxiety disorders (especially panic disorder), borderline personality disorder, and co-occurring depression and alcohol dependence.
Dementia praecox: The term coined by Kraepelin to describe what is currently known as schizophrenia. According to Kraepelin, this condition involves a degeneration of the brain that begins at a young age and ultimately leads to a disintegration of the entire personality.
Positive symptoms are viewed as direct lead-ins to full expression of psychosis. Clinicians often find it difficult to diagnose negative symptoms, because most people at one time or another act in these ways, as when they are fatigued or depressed.
Delusions: Beliefs that are grossly out of touch with reality. Hallucinations: A false perception not corresponding to the objective stimuli present in the environment. Affective flattening: A symptom of schizophrenia in which an individual seems unresponsive and which is reflected in relatively motionless body language and facial reactions as well as minimal eye contact. Alogia: Speechlessness or a notable lack of spontaneity or responsiveness in conversation. Avolition: Lack of initiative and unwillingness to act. Affective flattening: A symptom of schizophrenia in which an individual seems unresponsive and which is reflected in relatively motionless body language and facial reactions as well as minimal eye contact. Anhedonia: A loss of interest in or ability to experience pleasure from activities that most people find appealing.
Theories accounting for the origin of schizophrenia have traditionally fallen into two categories: biological and psychological. Cortical atrophy: A wasting away of tissue in the cerebral cortex of the brain. Loss of brain volume is particularly pronounced in the front and temporal lobes as well as the relay centers in the thalamus. Reduced brain activation: Functional deficits have been found in brain centers involved in the pleasant sensations of smell. Other areas are being explored. The dopamine hypothesis attributes the psychotic symptoms to overactivity of dopamine neurons. Antipsychotic medications reduced the frequency of hallucinations and delusions by blocking dopamine receptors. Drugs biochemically related to dopamine (such as amphetamines) increase frequency of psychotic symptoms
Neuroleptics: antipsychotic medications; major tranquilizers: Lowest potency- Chlorpromazine (Thorazine) and Thioridazine (Mellaril). Middle level of potency- Trifluoperazine (Stelazine) and Thiothixine (Navane). Most potent - Haloperidol (Haldol) and Fluphenazine (Prolixin). Tardive dyskinesia:
Examples of extreme negation: Rigid posturing or resistance to instruction. Example of peculiar movement: Bizarre posture. Echolalia: Senseless repetition of words or phrases. Echopraxia: Repetition by imitation of another’s movements.
Onset tends to occur earlier in life and interferes with personality development.
This is the most common type of schizophrenia.
The individual may show symptoms such as delusions, hallucinations, incoherence, or disorganized behavior, but does not meet the criteria for the paranoid (systematic bizarre delusions), catatonic (abnormalities of movement), or disorganized (disturbed or flat affect) types.
Splitting: Perceiving other people as being all good or all bad. Parasuicide: A suicidal gesture to get attention from loved ones, family, or professionals.
They want immediate gratification of their wishes and overreact to even minor provocations, usually in an exaggerated way, such as by weeping or fainting. Although their relationships are superficial, they assume them to be intimate and refer to acquaintances as “dear” friends.
Grandiosity: An exaggerated view of oneself as possessing special and extremely favorable personal qualities and abilities. Unrealistic, inflated sense of self-importance stemming from grave self-doubt. Common feature of other personality disorders, especially Histrionic and Borderline personality disorders
Treatment: Most promising is an approach geared toward helping them work on their styles of communication.
Convinced of their own inadequacies, they cannot make even the most trivial decisions on their own.
Elements of Abnormality <ul><li>Suffering </li></ul><ul><li>Maladaptiveness </li></ul><ul><li>Irrationality </li></ul><ul><li>Unpredictability </li></ul><ul><li>Observer Discomfort </li></ul><ul><li>Violations of Moral Standards </li></ul>
Diamond Perspective <ul><li>Determine which perspective is being used to explain the behavior </li></ul><ul><ul><li>Moral Model has been used to explain abnormal behavior </li></ul></ul><ul><ul><ul><li>Lack of will </li></ul></ul></ul><ul><ul><ul><li>Not strong enough </li></ul></ul></ul><ul><ul><ul><li>Something is wrong with me </li></ul></ul></ul>
DSM – IV Diagnostic & Statistical Manual of Mental Disorders <ul><li>Axis I: Clinical Syndromes </li></ul><ul><li>Axis II: Personality Disorders </li></ul><ul><li>Axis III: General Medical Conditions </li></ul><ul><li>Axis IV: Psychosocial and Environmental Conditions </li></ul><ul><li>Axis V: Global Assessment of Functioning Scale </li></ul>
Concerns about the DSM <ul><li>The danger of overdiagnosis </li></ul><ul><li>The power of diagnostic labels </li></ul><ul><li>Confusion of serious mental disorders with normal problems </li></ul><ul><li>The illusion of objectivity </li></ul>
Panic Disorder <ul><li>Neurotransmitters </li></ul><ul><li>Anxiety Sensitivity </li></ul><ul><li>Conditioned Fear Reactions </li></ul>Suggested explanations include: Biological relatives of people with panic disorder are 8 times more likely to develop this condition.
Panic Disorder <ul><li>Benzodiazepines </li></ul><ul><li>Antidepressants </li></ul><ul><li>Serotonin Reuptake Inhibitors </li></ul><ul><li>Relaxation Training </li></ul><ul><li>Panic Control Therapy (PCT) </li></ul>Treatments
Generalized Anxiety Disorder <ul><li>Generalized Anxiety Disorder: </li></ul><ul><li>An anxiety disorder characterized by anxiety that is not associated with a particular object, situation, or event, but seems to be a constant feature of a person's day-to-day existence. </li></ul>
Specific Phobias <ul><li>Specific Phobia: </li></ul><ul><li>An irrational and unabating fear of a particular object, activity, or situation that provokes an immediate anxiety response, disrupts functioning, and results in avoidance behavior. </li></ul>
Obsessive-Compulsive Disorder <ul><li>Obsessions associated with checking compulsions. </li></ul><ul><li>Need for symmetry and order. </li></ul><ul><li>Obsessions about cleanliness associated with washing compulsions. </li></ul><ul><li>Hoarding-related behaviors. </li></ul>4 Major Dimensions
OCD <ul><li>PET Scan of brain of person with obsessive/ compulsive disorder </li></ul><ul><li>High metabolic activity (red) in frontal lobe areas involved with directing attention </li></ul>
Trauma-Induced Disorders <ul><li>Intrusions and Avoidance </li></ul><ul><li>Hyperarousal and Numbing </li></ul>Symptoms fall into two related clusters: Post-Traumatic Stress Disorder: More than a month after a traumatic event, stress interferes with the individual’s ability to function.
Dissociative Disorders <ul><li>Amnesia </li></ul><ul><ul><li>conscious awareness becomes separated (dissociated) from previous memories, thoughts, and feelings </li></ul></ul><ul><ul><li>Psychogenic vs Organic Origins </li></ul></ul><ul><ul><ul><li>psychological need to escape/forget (psychogenic) </li></ul></ul></ul><ul><ul><ul><li>brain injury or disease (organic) </li></ul></ul></ul><ul><ul><li>Psychogenic “fugue” (to escape) </li></ul></ul><ul><ul><ul><li>Forgets entire past, identity </li></ul></ul></ul>
Dissociative Identity Disorder <ul><li>Dissociative Disorders </li></ul><ul><ul><li>conscious awareness becomes separated (dissociated) from previous memories, thoughts, and feelings </li></ul></ul><ul><li>Dissociative Identity Disorder </li></ul><ul><ul><li>rare dissociative disorder in which a person exhibits two or more distinct and alternating personalities </li></ul></ul><ul><ul><li>formerly called multiple personality disorder </li></ul></ul>
<ul><li>Dysphoric mood: </li></ul><ul><li>Unpleasant feelings, such as sadness or irritability. </li></ul>Euphoric mood : A feeling state that is more cheerful and elated than average, possibly even ecstatic. Euphoria Dysphoria
Cognitive Treatment <ul><li>COGNITIVE RESTRUCTURING </li></ul><ul><ul><li>Client identifies and monitors dysfunctional automatic thoughts. </li></ul></ul><ul><ul><li>Client learns to recognize connection between thoughts, emotions, and actions. </li></ul></ul><ul><ul><li>Client evaluates the reasonable of the automatic thoughts. </li></ul></ul><ul><ul><li>Clients learns to substitute more reasonable thoughts. </li></ul></ul><ul><ul><li>Client must identify and alter dysfunctional assumptions. </li></ul></ul>
Suicide Risk Factors <ul><li>Demographic or Social Factors </li></ul><ul><ul><li>Young or elderly male </li></ul></ul><ul><ul><li>Native American or Caucasian </li></ul></ul><ul><ul><li>Single (especially if widowed) </li></ul></ul><ul><ul><li>Economic/occupational stress </li></ul></ul><ul><ul><li>Incarceration </li></ul></ul><ul><ul><li>Gambling history </li></ul></ul><ul><ul><li>Easy access to firearm </li></ul></ul>
Suicide Risk Factors <ul><li>Clinical Factors </li></ul><ul><ul><li>Major psychiatric illness </li></ul></ul><ul><ul><li>Personality disorder </li></ul></ul><ul><ul><li>Impulsive or violent traits </li></ul></ul><ul><ul><li>Current medical illness </li></ul></ul><ul><ul><li>Family history of suicide </li></ul></ul><ul><ul><li>Previous self-injurious acts or attempts </li></ul></ul><ul><ul><li>Anger, agitation, excessive preoccupation </li></ul></ul><ul><ul><li>Abuse of alcohol, drugs, heavy smoking </li></ul></ul><ul><ul><li>Easy access to toxins (including medicines) </li></ul></ul><ul><ul><li>Suicide plans, preparation, or note </li></ul></ul><ul><ul><li>Low ambivalence about dying vs. living </li></ul></ul>
MRI scans show that a person with Schizophrenia (left) is more likely than a healthy person (right) to have enlarged ventricles.
BIOLOGICAL TREATMENT <ul><li>NEUROLEPTICS </li></ul><ul><li>Vary in potency. </li></ul><ul><li>All block dopamine receptors. </li></ul><ul><li>Side effects: </li></ul><ul><ul><li>Tardive dyskinesia </li></ul></ul><ul><ul><li>Compromise of immune system </li></ul></ul>
Flu Virus <ul><li>Some flu viruses interfere with the normal migration of brain cells </li></ul><ul><ul><li>- Second tri-mester of pregnancy is the critical period </li></ul></ul>
<ul><li>Characterized by at least two bodily movement abnormalities: </li></ul><ul><li>Motor immobility or stupor. </li></ul><ul><li>Purposeless motor activity. </li></ul><ul><li>Mutism or extreme negation. </li></ul><ul><li>Peculiarities of movement or odd mannerisms and grimacing. </li></ul><ul><li>Echolalia </li></ul>TYPES OF SCHIZOPHRENIA Catatonic Type
<ul><li>Characterized by a combination of symptoms, including disorganized speech and behavior and flat or inappropriate affect. </li></ul><ul><li>Even delusions and hallucinations lack a coherent theme. </li></ul>TYPES OF SCHIZOPHRENIA Disorganized Type
<ul><li>Characterized by preoccupation with one or more bizarre delusions, or with auditory hallucinations that are related to a particular theme of being persecuted or harassed. </li></ul><ul><li>Without disorganized speech or disturbed behavior. </li></ul>TYPES OF SCHIZOPHRENIA Paranoid Type
TYPES OF SCHIZOPHRENIA <ul><li>Characterized by a complex of schizophrenic symptoms that does not meet the criteria for other types of schizophrenia. </li></ul>Undifferentiated Type
NARCISSISTIC PERSONALITY DISORDER <ul><li>Named for Greek legend of Narcissus . </li></ul>Personality disorder characterized by an unrealistic, inflated sense of self-importance and lack of sensitivity to other people ’s needs. <ul><li>egotistical </li></ul><ul><li>arrogant </li></ul><ul><li>exploitative of others </li></ul>Narcissistic
PARANOID PERSONALITY DISORDER <ul><li>SUSPICIOUSNESS </li></ul><ul><li>GUARDEDNESS </li></ul><ul><li>PROJECTION OF NEGATIVITY AND DAMAGING MOTIVES ONTO OTHERS </li></ul><ul><li>ATTRIBUTION OF THEIR PROBLEMS TO OTHERS </li></ul><ul><li>LOW SELF-EFFICACY </li></ul>
<ul><li>INDIFFERENCE TO SOCIAL AND SEXUAL RELATIONSHIPS </li></ul><ul><li>SECLUSIVE; PREFER TO BE ALONE </li></ul><ul><li>NO DESIRE TO LOVE OR BE LOVED </li></ul><ul><li>COLD, RESERVED, WITHDRAWN </li></ul><ul><li>INSENSITIVE TO FEELINGS OF OTHERS </li></ul>TREATMENT: Unlikely to seek or respond to therapy. Schizoid
<ul><li>FEAR OF ABANDONMENT </li></ul><ul><li>DESPONDENT WITHOUT OTHERS </li></ul><ul><li>UNABLE TO INITIATE ACTIVITIES </li></ul><ul><li>INSECURE ABOUT MAKING DECISIONS WITHOUT OTHERS </li></ul><ul><li>GO TO EXTREME TO GAIN APPROVAL OF OTHERS </li></ul><ul><li>DEVASTATED WHEN RELATIONSHIPS END </li></ul>dependent
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