Mental disorders


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  • Along with a mood disorder, 'exaggerated fright/startle response' seems to be the most pervasive and disrupting for me. I have worked in the field, yet have a difficult time in self-treatment, and also a hard time trying to explain the startle response to others (so they may be aware).
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Mental disorders

  1. 1. The balance between all aspects of life. Physical Social Spiritual Emotional
  2. 2. Far more than the absence of mental illness and hasto do with many aspects of ourlives including:• How we feel about our selves• How we feel about others• How we are able to meet the demands of life
  3. 3. MAINTAINING MENTAL HEALTH INVOLVES:• Attention to lifestyle• Social contact• Reviewing lifestyle from time to time• Awareness of reaction of mind and body• Having people in our lives to trust• Awareness on what can go wrong• Taking steps to resolve problem
  4. 4. Mental Disorders  5
  5. 5. Definition  Mental disorders – disturbances of an individual’s behavioral or psychological functioning that are not culturally accepted and that lead to psychological distress, behavioral disability, and/or impaired overall functioning (Baron, 2005).  6
  6. 6. Definition  Leventhal et al (2009) use 5 criteria in defining mental illness:  Statistical rarity- many mental disorders are uncommon.  Subjective distress- most although not all mental illness causes emotional pain.  Impairment- most mental disorders interfere with individuals daily functioning.  Societal disapproval- we often stereotype and discriminate against individuals with mental disorders.  Biological dysfunction- failures in biological systems.7
  7. 7. Mental disorders THEN AND NOW CAUSES  1400’s- moon influenced brain and induced madness  Supernatural forces  Possession of evil spirits  Physical factors- brain damage, hereditary TREATMENT  Asylums  Exorcism  Beaten  Starved  Rest, good food and drink and solitude  Trephening, bloodletting, snake pits8
  9. 9.  Biological model- role of the nervous system in mental disorders. Seeks to understand such disorders in terms of malfunctions in portions of the brain, imbalance in various neurotransmitters and genetic factors  Psychological model emphasizes psychological factors in the development of mental disorders; for instance many psychologists believe that learning play a key role in many mental disorders .e.g. learning phobias  Sociocultural factors – emphasizes external factors such as negative environments – poverty, homelessness, unemployment, inferior education, prejudice as potential causes of some mental disorders.    Diathesis-stress model – mental disorders result from a predisposition for a given disorder (diathesis) and stressors in an individual’s environment that tend to activate or stimulate the predisposition.10
  10. 10. Psychiatric Diagnosis across cultures Ataque de nervios Symptoms commonly include uncontrollable shouting, (Latin America, Latin attacks of crying, trembling, heat in the chest rising into Mediterranean, the head, and verbal and physical aggression.   Caribbean)  Symptoms may include watering or dry eyes, dizziness, Brain fag or brain fog blurring of vision, difficulty concentrating or remembering, (West Africa)   pain or feelings of pressure in the head or neck, fatigue and difficulty sleeping, shaking hands, rapid heartbeat, crawling Studiation Madness sensations under the skin, feelings of weakness and (Trinidad)  depression.   Mal de ojo "evil eye". A common term to describe the cause of disease, (Mediterranean)  misfortune, and social disruption.  Windigo Psychosis occurs when a person becomes filled Windigo Psychosis with anxiety that they are becoming a cannibal, and may (Native American) increasingly view those around them as edible. Latah is an exaggerated startle response, typically found Latah (Malaysia) among women. Being surprised may result in screaming, cursing, dancing and hysterical laughter that might last a half hour or more.  11
  11. 11. Assessment and Diagnosis of Mental Disorders DSM-IV Diagnostic and Statistical Manual of Mental Disorder – IV12
  12. 12.  It is the official diagnostic tool used by psychologist.This manual help psychologist to describe and classify mental disorders. Major Diagnostic Categories – page 539.  The book describes diagnostic features- symptoms that must be present. It looks at variations in age, gender, culturally related features, some things that are normal in one culture are not abnormal in others (eg. incest – African tribes).  Disorders are classified along five axes – Axis I – clinical disorder, Axis II – personality disorder/mental retardation, Axis III – medical conditions, Axis IV- psychosocial or environmental conditions, and Axis V- GAF – global assessment functioning.    13
  13. 13. Limitation of the DSM-IV  The manual is mainly descriptive – doesn’t attempt to explain.  The manual also attaches labels to people and the person may then be perceived in terms of that label – certain stigma associated.14
  16. 16. 1. Disruptive Disorder Divided into two categories: 1. Oppositional defiant disorder 2. Conduct disorder.  The essential feature of ODD- a recurrent pattern of negativistic, defiant, disobedient, and hostile behavior toward authority figures that persists for at least 6 months.  Usually start when children are young (ages 3 to 7) and can lead to more serious disorder – conduct disorder which begins17 somewhat later – puberty.
  17. 17. Conduct disorder  Involves more serious antisocial behaviors that go beyond throwing tantrums or disobeying rules.  Here the child impedes on the basic rights of others and violates major age-appropriate societal norms or rules.  Children are seen as being aggressive towards people and animals, destroying property, being deceitful and engaging in theft, violations of rules – i.e. running away, staying out at night, truant from school.18
  18. 18. Attention-Deficit/Hyperactivity Disorder (ADHD) ADHD – persistent pattern of inattention and/or hyperactivity that is more frequent and severe than is typically observed in individuals at a comparable level of development. Causes are both biological and psychological. Low birth weight, oxygen deprivation at birth, and alcohol or drug consumption. Psychological factors include parental intrusiveness or over stimulation – parents who just can’t seem to leave their infants alone. Treated with drugs – Ritalin19
  19. 19. 2. Feeding and Eating Disorders  Disturbances in eating behavior that involve maladaptive and unhealthy efforts to control body weight. a. Anorexia Nervosa  Excessive and intense fear of gaining weight coupled with refusal to maintain a normal body weight.  More common in women than in men. Why? Sociological factors – women feel pressure to live up to the images of beauty shown in the media. Psychological control – family pressures20
  20. 20. b. Bulimia  Persons engage in recurrent episodes of binge eating – eating huge amounts of food within short periods of time and then engage in some activity that will prevent them from gaining weight.    Usually women, and unlike anorexics, bulimics are of normal weight – so it is harder to detect that something is wrong with them.  Seem to have same sociological causes – wanting to be thin as defined by society.21
  21. 21. Autism: Pervasive Developmental Disorder  Involve lifelong impairment in mental or physical functioning. The essential features of autism are the presence of  abnormal or impaired development in social interaction – don’t use nonverbal behaviors such as eye contact and communication and  a restricted repertoire of activity or interest – repetitive pattern of behaviors.  Children with this disorder seem to be preoccupied with themselves and to live in a private world.22
  22. 22. 3. Mood Disorders  Demonstration of swings in mood – from very elated to very dejected. Although we have all felt some level of sadness or happiness – persons suffering from a mood disorder have swings that are extreme, prolonged and impair daily functioning.  23
  23. 23. What constitute the diagnosis of depression?  Major Depressive Episode  Persons suffering from depression should have five or more symptoms for at least 2 consecutive weeks.  Symptoms include profound unhappiness most of the day, nearly every day; diminished interest or pleasure in all, or almost all activities – eating, sports, sex; significant weight loss when not dieting or weight gain; insomnia or hypersomnia; fatigue or loss of energy; psychomotor agitation or retardation (feeling of restlessness or being slowed down); recurrent thoughts of death, diminished ability to think or concentrate.24
  24. 24. Bipolar Disorder  Characterized by wide swings in mood between deep depression and mania.  Causes – biological and psychological. Depression runs in family – this support the argument for biological causes.  Research also shows that there seem to be some abnormality in brain biochemistry. It is found that levels of norepinephrine and serotonin are lower in the brains of those suffering from depression.  They also found that these two neurotransmitters were higher in those suffering from mania25
  25. 25.  Psychological factors – learned helplessness – beliefs that outcomes of events are out of the control of the individual. One result in feelings of learned helplessness is depression.    Negative views about oneself also lead to feelings of depression. These persons possess negative self-schemas – that is negative conceptions of their own traits, abilities, and behavior.26
  26. 26. 4. Anxiety Disorders27
  27. 27. a. Phobias– excessive fear that causes intense emotional distress and impairs daily functioning.  Most common phobia is social phobia – persistent fear of social or performance situations in which embarrassment may occur.  Exposure to the social or performance situation almost invariably provokes an immediate anxiety response, such as panic attack.    Causes –Psychological factors – learning – classical conditioning.28
  28. 28. b. Panic Disorder and Agoraphobia  Panic attacks are what lead to a person being diagnosed with a panic disorder. Panic attacks are characterized by periodic, unexpected attacks of intense, terrifying anxiety. Some panic attacks occur due to specific situation.  One such case is panic disorder that is associated with agoraphobia, or fear of situations from which escape might be difficult or in which help may not be available. Take the form of intense fear of open spaces, fear of being in public, fear of traveling or fear of having a panic attack while away from home.  Claustrophobia – fear of enclosed spaces29
  29. 29. c. Obsessive-Compulsive Disorder  Recurrent obsessions (thoughts) and compulsions (actions) that are severe enough to be time consuming or causes marked distress or significant impairment.  Most common fear is those of dirt, germs, or touching infected people or objects, disgust over body waste or secretions. The compulsive actions include repetitive hand washing, checking doors, windows, water, and gas; counting objects a precise number of times or repeating an action a specific number of times, and hoarding old mail, newspaper and other useless objects.30
  30. 30. d. Posttraumatic Stress Disorder (PTSD)  Disorder in which people persistently re-experience a traumatic event in their thoughts or dreams.  Feel as if they are reliving the event from time to time.  Persistently avoid stimuli associated with the traumatic event.  Persistently experience 2 or more of the following symptoms of increased arousal such as difficulty falling or staying asleep/ irritability or outbursts of anger, difficulty concentrating; hypervigilance; exaggerated startle response.31
  31. 31. 6. Dissociative Disorders  They involve profound losses of identity or memory, intense feelings of unreality, a sense of being depersonalized (i.e. separate from oneself), and uncertainty about one’s own identity32
  32. 32. a. Dissociative amnesia  Individuals suddenly experience a loss of memory that does not stem from medical conditions or other mental disorders.  Such losses can be localized, involving only a specific period of time, or generalized, involving memory for the person’s entire life b. Dissociative Fugue  An individual suddenly leaves home and travels to a new location where he or she has no memory of his or her previous life.33
  33. 33. b. Dissociative Identity Disorder  Also known as Multiple Personality Disorder in the past  Involves a shattering of personal identity into two- and often more- separate but coexisting personalities, each possessing different traits, behaviors, memories, and emotions  Usually there is one host personality- the primary identity that is present most of the time, and one or more alters- alternative personalities that appear from time to time34
  34. 34. 7. Somatoform Disorders Involves experiencing physical symptoms for which there is no apparent physical cause.  35
  35. 35. a. Hypochondriasis  Fear of having or the idea that one has a serious disease based on a misinterpretation of one or more bodily signs or symptoms.  Even after assurance from their doctors they continue to worry. Many hypochondriacs are not faking; they feel the pain and discomfort they report.  36
  36. 36. b. Munchausen’s syndrome Parent-child/Self-mutilation  Disorder where patients pretend to have illness and therefore are subject to many medical tests and surgical procedures  These persons are usually faking. Devote their lives to seeking – and often obtaining – costly and painful medical procedures they know they don’t need.  Why? Maybe to get attention.37
  37. 37. c. Conversion disorder  Persons actually experience physical problems such as motor deficits (paralysis) or sensory deficits (blindness). No medical conditions to account for deficits.    Causes – Psychological factors – focus on inner sensations – they tend to perceive normal bodily sensations as being more intense and disturbing than most people. Tend to be highly negativistic – low self- esteem.  Sociological factors – persons learn that they will get more attention and better treatment – patients are reinforced.38
  38. 38. 8. Sexual Disorders  Sexual dysfunction is characterized by a disturbance in the process that characterize the sexual response cycle (attain orgasm, erections) or by pain associated with sexual intercourse.  Sexual desire disorder involves a lack of interest in sex or active aversion to sexual activity. Persons report that they rarely have sexual fantasies and that they avoid almost all sexual activity and this causes them39 distress.
  39. 39.  Sexual arousal disorder involves the inability to attain or maintain an erection (male erectile disorder) or the absence of vaginal swelling and lubrication (female sexual arousal disorder).  Orgasm disorder includes the delay or absence of orgasms in both sexes (female/male orgasmic disorder) and premature ejaculation (reaching orgasm too quickly) in males.40
  40. 40. Sexual pain disorders  Dyspareunia – genital pain that is associated with sexual intercourse in either males or females. Causes marked distress.  Vaginismus – recurrent or persistent involuntary spasm of the musculature of the outer third of the vagina that interferes with sexual intercourse. Causes marked distress.41
  41. 41. Paraphilias  Recurrent and intense sexually arousing fantasies, sexual urges or behaviors generally involving  nonhuman objects,  the suffering or humiliation of oneself or one’s partner, or  children or other non-consenting persons that occurs over a period of at least 6 months. These things are necessary for sexual arousal.42
  42. 42. 9. Gender Identity Disorders  These persons feel that they were born with the wrong sexual identity.  Identify with the opposite sex and show preference in cross- dressing. Many of these people undergo sex-change operations – sexual organs are altered to resemble the other gender.  People usually undergo years of hormonal therapy and counseling before the actual therapy.  43
  43. 43. 10. Schizophrenia44
  44. 44.  Described as the most devastating mental disorder. Fragmentation of basic psychological functions (attention, perception, thought, emotions, and behavior). Problems with adjusting to the demands of reality. Misperceive what is happening around them, often hearing and seeing things that aren’t there (hallucinations). Trouble paying attention to what is going on around them, thinking is often confused and disorganized that they cannot communicate w/others. Bizarre behavior and blunting emotions.45
  45. 45.  Characterized as having psychotic symptoms. The essential features of schizophrenia are a mixture of both positive and negative symptoms.  Positive symptoms – adding something that is not normally there. Include delusions, hallucinations, disordered thought processes, and disordered behavior.  Delusions are misinterpretations of normal events and experiences. 1) Delusion of persecution 2) Delusion of grandeur 3) Delusion of control. These are phasic – meaning they come and go – just like most of the positive symptoms.46
  46. 46.  Hallucinations – seeing and hearing things that aren’t really there. Usually voices telling them what to do.  Disorganized speech – word salad (jumbled words), frequent derailment (start with one thought and go off into another) or incoherence, create their own words. All this seems to stem from the fact the schizophrenics are easily distracted – lack capacity for selective attention.  Disorganized behaviors – odd movements or strange gestures or no movement at all for long periods of time – catatonia.47
  47. 47.  Negative symptoms – absence of functions or reactions that most persons show.  Flat affect – no emotion – stare off in space with a glazed look. When they do show emotion it is often times inappropriate – may laugh at funerals and cry at birthday parties.  Avolition – lack of motivation or will – persons may sit down doing nothing for hours.  Alogia – lack of speech – may answer direct questions, but otherwise tend to remain silent – w/drawn into private world.48
  48. 48. Onset and Course • Chronic disorder • Last for at least 6 months. For most people however it lasts for much longer and symptoms come and go. • People with the disorder have period when they appear almost normal, and long periods when their symptoms are readily apparent • Generally begins in early 20s. Equal among gender, although males have earlier onset than females.49
  49. 49. Five types of Schizophrenia  Catatonic – unusual patterns of motor activity, such as: catalepsy or stupor; excessive motor activity (purposeless); extreme negativism; mutism; speech disturbances such as echolalia (repetition or words) or echopraxia – automatic imitation of movements.  Disorganized – disorganized speech, disorganized behavior, flat or inappropriate affect.  Paranoid – preoccupation with one or more sets of delusions, centered around the belief that others are out to get him50
  50. 50.  Undifferentiated – many symptoms, including delusion, hallucination, incoherence  Residual – withdrawal, minimum affect, and absence of motivation; occurs after prominent delusions and hallucinations are no longer present51
  51. 51. Causes  Genetic factors – run in families – twin studies.  Biological factors – brain dysfunction – larger ventricles may produce abnormalities in the cerebral cortex. Reduced activity in the frontal lobes. (page 570).  Biochemical factors – neurotransmitters disturbance – high levels of dopamine.  Psychological factors – families create environments that place their children at risk. Studies done on relapse shows - harsh criticism, hostility, and show too much concern with their problems.52
  52. 52. 10. Personality Disorders53
  53. 53.  Extreme and inflexible patterns of perceiving, relating to, and thinking about the environment and oneself that are exhibited in a wide range of social and personal contexts.  Most personality disorders are said to be ego-syntonic – that means that they are in sync with the ego and not distressing to person experiencing the disorder.  However, there are a few of the disorders that are ego- dystonic – out-of-sync- with the ego and thus cause the person problems. These people will usually seek help as oppose to the former.54
  54. 54. Three clusters of Personality disorders  Odd and Eccentric PD.  Dramatic, Emotional, and Erratic PD.  Anxious and Fearful PD55
  55. 55. Odd and Eccentric PD. Paranoid PD – pervasive distrust and suspiciousness of others Schizoid PD – pervasive pattern of detachment from social relationships and a restricted range of expression of emotions in interpersonal settings – lack basic social skills. Schizotypal – pervasive pattern of social and interpersonal deficits marked by acute discomfort, cognitive and perceptual distortions, and eccentric behaviour56
  56. 56. . Dramatic, Emotional, and Erratic PD  Histrionic PD –pervasive pattern of excessive emotionality and attention seeking.  Narcissistic PD – pervasive pattern of grandiosity in fantasy or behavior, need for admiration, and lack of empathy.  Antisocial PD – pervasive pattern of disregard for and violation of the rights of others. Deceitfulness, impulsivity, irritability, lack of remorse g. Borderline PD – pervasive pattern of instability of interpersonal relationships, self-image and affect.57
  57. 57. Anxious and Fearful PD  Avoidant PD – pervasive pattern of social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation.  Obsessive-Compulsive PD –preoccupation with orderliness, perfectionism, and need for mental and interpersonal control at the expense of flexibility, openness and efficiency.  Dependent PD – pervasive and excessive need to be taken care of that leads to submissive and clinging behavior and fears of separation.58
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