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Units 32 35

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Units 32 35

  1. 1. Psychological Disorders
  2. 2. Disorders <ul><li>Abnormal psychology (“psychopathology”) </li></ul><ul><li>Diagnosis </li></ul><ul><ul><ul><li>Observing patient’s symptoms and inferring disorder </li></ul></ul></ul><ul><ul><ul><li>Symptoms appear in clusters called syndromes </li></ul></ul></ul><ul><li>Prognosis </li></ul><ul><ul><ul><li>Refers to prediction about the course of identified disorder over time </li></ul></ul></ul>
  3. 3. Mental Illness <ul><li>Neurotic disorders </li></ul><ul><ul><ul><li>Primary symptoms include anxiety or defenses to ward off anxiety (phobias, OCD, PTSD) </li></ul></ul></ul><ul><ul><ul><li>Symptoms may cause distress or impair functioning but generally allow for social functioning </li></ul></ul></ul><ul><li>Psychotic disorders </li></ul><ul><ul><ul><li>Includes more severe or “serious” mental disorders </li></ul></ul></ul><ul><ul><ul><li>Thoughts and actions no longer meet the demands of reality (schizophrenia, dissociative disorders) </li></ul></ul></ul>
  4. 4. Mental Illness <ul><li>Theoretical models of psychopathology </li></ul><ul><ul><ul><li>Biomedical/biopsychosocial perspective </li></ul></ul></ul><ul><ul><ul><li>Psychodynamic perspective </li></ul></ul></ul><ul><ul><ul><li>Behavioral perspective </li></ul></ul></ul><ul><ul><ul><li>Cognitive perspective </li></ul></ul></ul><ul><ul><ul><li>Systems perspective </li></ul></ul></ul>
  5. 5. Biological Perspective <ul><li>Emphasizes the physical and biological bases of behavior </li></ul><ul><li>Examines pathology within the brain </li></ul><ul><ul><ul><li>Abnormality stems from disturbances in brain activity, neurotransmitter problems, and/or chemical imbalances </li></ul></ul></ul><ul><li>Strongly influenced by neuroscience </li></ul><ul><ul><ul><li>MRI and PET scans re: schizophrenia </li></ul></ul></ul>
  6. 6. Psychodynamic Perspective <ul><li>Abnormal behavior results from: </li></ul><ul><ul><li>a) Unresolved psychological conflicts in early childhood </li></ul></ul><ul><ul><li>b) Conflict between selfish desires of Id and the demands of society/personal conscience of Superego </li></ul></ul><ul><li>Emphasizes attacking defense mechanisms + provoking a catharsis </li></ul>
  7. 7. Behavioral Perspective <ul><li>Behaviors learned through conditioning and society can provide deviant/maladaptive models that children imitate </li></ul><ul><li>Overcoming issues occurs by providing positive learning experiences, healthy models, and rewarding positive behavior </li></ul><ul><li>Note: only some mental disorders neatly fit this model (i.e., Little Albert) </li></ul>
  8. 8. Cognitive Perspective <ul><li>Abnormal behavior results from distorted/irrational thinking that leads to maladaptive behavior </li></ul><ul><li>Focuses on the role of patient interpretations and expectations (thoughts) in generating/sustaining emotion </li></ul><ul><li>Offers useful understanding of depression </li></ul><ul><ul><ul><li>“ Automatic thought process” – depression result of thinking negative/depressing thoughts about life’s experiences </li></ul></ul></ul>
  9. 9. Systems Perspective <ul><li>Looks for the root of an individual’s problem behavior within a broader social context (i.e., the family) </li></ul><ul><li>Abnormality stems from dysfunctional group relations within the family </li></ul><ul><li>Focus of counseling treatment becomes the family system (not the problem or symptomatic family member) </li></ul>
  10. 10. Mental Illness <ul><li>DSM-IV </li></ul><ul><ul><li>Classifies signs and symptoms into syndromes </li></ul></ul><ul><ul><ul><li>Signs = observable phenomena the patient exhibits </li></ul></ul></ul><ul><ul><ul><li>Symptoms = what patients reports to health care professional </li></ul></ul></ul><ul><ul><li>Uses a multi-axial/multidimensional approach to diagnose mental illness along 5 dimensions </li></ul></ul><ul><ul><li>Diagnostic classification allows for description, future course prediction, and treatment </li></ul></ul>
  11. 11. DSM-IV <ul><li>Axis I: Clinical Syndromes </li></ul><ul><li> - Signs and symptoms that cause distress (states) </li></ul><ul><li> II: Developmental Disorders </li></ul><ul><li> - Personality/developmental disorders (traits) </li></ul><ul><li> III: Physical Conditions </li></ul><ul><li> - Medical conditions (if any) </li></ul><ul><li>IV: Severity of Psychosocial Pressures </li></ul><ul><li> - Psychosocial/environmental problems </li></ul><ul><li>V: Highest Level of Functioning </li></ul><ul><li> - Global assessment of functioning </li></ul>
  12. 12. Mental Illness <ul><li>How to define “abnormal”? </li></ul><ul><ul><ul><li>Statistical frequency (outliers = abnormal) </li></ul></ul></ul><ul><ul><ul><li>Maladaptiveness </li></ul></ul></ul><ul><ul><ul><li>Subjective feelings of distress </li></ul></ul></ul><ul><ul><ul><li>DSM-IV </li></ul></ul></ul>
  13. 13. Mood Disorders <ul><li>Depression/Major Depressive Disorder </li></ul><ul><ul><li>Classified as a disorder when: </li></ul></ul><ul><ul><ul><li>1) Magnitude of reaction (sadness) out of proportion to </li></ul></ul></ul><ul><ul><ul><li>stimulus </li></ul></ul></ul><ul><ul><ul><li>2) Sadness is long-lasting (5+ months) </li></ul></ul></ul><ul><ul><li>Gender differences </li></ul></ul><ul><ul><ul><li>Women 2x as likely to experience major depression </li></ul></ul></ul><ul><ul><ul><li>Why? </li></ul></ul></ul>
  14. 14. Mood Disorders <ul><li>Causes of depression </li></ul><ul><ul><li>Psychoanalytic – a reaction to loss coupled with suppressed/stifled anger </li></ul></ul><ul><ul><li>Behaviorism – lack of positive reinforcement from others </li></ul></ul><ul><ul><li>Cognitive – negative self-schemas that are global AND stable; failures are magnified while successes are minimized; change in thoughts = change behavior </li></ul></ul><ul><ul><li>Biological – neurotransmitter deficiencies </li></ul></ul>
  15. 15. Mood Disorders <ul><li>Symptoms of depression </li></ul><ul><ul><ul><li>Emotional – sadness, hopelessness, “flat affect” </li></ul></ul></ul><ul><ul><ul><li>Cognitive – low self-esteem, pessimism, poor attention </li></ul></ul></ul><ul><ul><ul><li>Motivational – passivity, loss of drive to initiate activity </li></ul></ul></ul><ul><ul><ul><li>Physical – appetite loss, sleep disturbances, fatigue </li></ul></ul></ul><ul><ul><ul><li>Behavioral – spontaneous crying, chronic irritability </li></ul></ul></ul>
  16. 16. Mood Disorders <ul><li>Treating depression </li></ul><ul><ul><li>Therapy </li></ul></ul><ul><ul><li>Antidepressants/SSRIs (Paxil, Zoloft, Prozac) </li></ul></ul><ul><ul><li>Electro-convulsive/electro-shock therapy </li></ul></ul><ul><ul><ul><li>Intentional induction of electric shock administered the brain to induce seizure </li></ul></ul></ul><ul><ul><ul><li>Immediate improvement but can cause memory loss </li></ul></ul></ul><ul><ul><ul><li>Researchers exploring less traumatic ways to alter electric </li></ul></ul></ul><ul><ul><ul><li>activity in brain (i.e., Transcranial Magnetic Stimulation?) </li></ul></ul></ul>
  17. 17. Mood Disorders <ul><li>Bipolar disorder </li></ul><ul><ul><li>“Manic depressive disorder” </li></ul></ul><ul><ul><li>Alternating episodes of mania and depression </li></ul></ul><ul><ul><ul><li>Mania = Extreme euphoria, racing thoughts, hyperactivity, little need for sleep </li></ul></ul></ul><ul><ul><ul><li>Low overall incidence rate (~0.5 – 1.6%) but high suicide rate (10 – 20%) </li></ul></ul></ul><ul><ul><li>Treatment </li></ul></ul><ul><ul><ul><li>Mood stabilizers (Lithium, Valproate) </li></ul></ul></ul>
  18. 18. Schizophrenia <ul><li>Symptoms </li></ul><ul><ul><ul><li>Disturbances of thought/attention </li></ul></ul></ul><ul><ul><ul><li>Perceptual disturbances (louder noise, more intense color) </li></ul></ul></ul><ul><ul><ul><li>Language disturbances (‘word salad’ – “why’s Wise wise?”) </li></ul></ul></ul><ul><ul><ul><li>Loss of attentional focus </li></ul></ul></ul><ul><ul><ul><li>Neologism – make up words that sound logical (“She is prastigitious”) </li></ul></ul></ul><ul><ul><ul><li>Associational chaining </li></ul></ul></ul>
  19. 19. <ul><li>Symptoms (con’t) </li></ul><ul><ul><ul><li>Affective disturbances (flat affect in inappropriate situations) </li></ul></ul></ul><ul><ul><ul><li>Withdrawal from reality/complete catatonia </li></ul></ul></ul><ul><ul><ul><li>Hallucinations (“see the spies coming”, hear things) </li></ul></ul></ul><ul><ul><ul><li>Delusions or beliefs inconsistent with reality </li></ul></ul></ul><ul><ul><ul><ul><li>… of thoughts/influence (others’ brainwaves can influence them) </li></ul></ul></ul></ul><ul><ul><ul><ul><li>… of persecution (convinced people are coming for them) </li></ul></ul></ul></ul><ul><ul><ul><ul><li>… of grandeur (false beliefs they are greater than they really are) </li></ul></ul></ul></ul><ul><ul><ul><ul><li>… of paranoia (high suspicion, constantly being watched) </li></ul></ul></ul></ul>Schizophrenia
  20. 20. <ul><li>2 types of onset </li></ul><ul><ul><ul><li>a) Acute </li></ul></ul></ul><ul><ul><ul><li> - Patient endures a stressor, followed by hallucinations </li></ul></ul></ul><ul><ul><ul><li> - Better chance for treatment (address the stressor) </li></ul></ul></ul><ul><ul><ul><li>b) Chronic </li></ul></ul></ul><ul><ul><ul><li> - Slow, gradual deterioration of the individual </li></ul></ul></ul><ul><ul><ul><li>- Actual cause unknown and therefore unclear what treatment option is best </li></ul></ul></ul>Schizophrenia
  21. 21. <ul><li>Major types </li></ul><ul><ul><ul><li>Paranoid </li></ul></ul></ul><ul><ul><ul><li>Disorganized </li></ul></ul></ul><ul><ul><ul><li>Catatonic </li></ul></ul></ul><ul><ul><ul><li>Undifferentiated </li></ul></ul></ul><ul><ul><ul><li>Residual </li></ul></ul></ul>Schizophrenia
  22. 22. <ul><li>Causes </li></ul><ul><ul><li>Biological considerations </li></ul></ul><ul><ul><ul><li>Appears to have a genetic link (i.e., runs in families) </li></ul></ul></ul><ul><ul><ul><li>Identical twin = ~50% probability </li></ul></ul></ul><ul><ul><li>Social causes </li></ul></ul><ul><ul><ul><li>Genetics alone not sufficient cause for schizophrenia </li></ul></ul></ul><ul><ul><ul><li>Low SES? </li></ul></ul></ul>Schizophrenia
  23. 23. <ul><li>Treatments(?) </li></ul><ul><ul><li>Anti-psychotic medications </li></ul></ul><ul><ul><ul><li>Thorazine – not a perfect drug! </li></ul></ul></ul><ul><ul><ul><ul><li>Causes dyskinesia </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Tolerance issues </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Is “zombification” a cure? </li></ul></ul></ul></ul><ul><ul><ul><li>Respiridone? </li></ul></ul></ul>Schizophrenia
  24. 24. Anxiety Disorders <ul><li>Characterized by intense feelings of distress, anxiety, and/or apprehension </li></ul><ul><li>Anxiety problematic when feelings become distressing to the point they interfere with daily life </li></ul><ul><li>Generalized Anxiety Disorder, phobias, Obsessive Compulsive Disorder (OCD) </li></ul>
  25. 25. Anxiety Disorders <ul><li>Phobias </li></ul><ul><ul><li>Characterized by intense or irrational fear </li></ul></ul><ul><ul><li>Individual often aware the fear is groundless but will continue to experience the phobia nonetheless </li></ul></ul><ul><ul><li>Common cause = classical conditioning? </li></ul></ul><ul><ul><li>Types of phobias </li></ul></ul><ul><ul><ul><li>Simple phobia (of a specific object like spiders) </li></ul></ul></ul><ul><ul><ul><li>Social phobia (fear of public situations) </li></ul></ul></ul><ul><ul><ul><ul><li>Agoraphobia – fear of being in open places and unable to escape (usually crowds) </li></ul></ul></ul></ul>
  26. 26. Anxiety Disorders <ul><li>Obsessive compulsive disorder (OCD) </li></ul><ul><ul><li>Extremely persistent obsession (unwelcome thoughts) and compulsions (unwelcome behavior) </li></ul></ul><ul><ul><li>Obsessive thoughts/compulsive behaviors problematic if interferes with quality of life </li></ul></ul><ul><li>Several varieties of OCD </li></ul><ul><ul><ul><li>Arrangers </li></ul></ul></ul><ul><ul><ul><li>Cleaners </li></ul></ul></ul><ul><ul><ul><li>Counters </li></ul></ul></ul><ul><ul><ul><li>Checkers </li></ul></ul></ul><ul><ul><ul><li>Clutterers/hoarders </li></ul></ul></ul>
  27. 27. Anxiety Disorders <ul><li>Treating anxiety </li></ul><ul><ul><li>“ Systematic desensitization” </li></ul></ul><ul><ul><li>Benzodiazepines/tranquilizers (Valium, Xanax) </li></ul></ul><ul><ul><ul><li>Problems/concerns: </li></ul></ul></ul><ul><ul><ul><ul><li>Dependency </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Doesn’t necessarily treat underlying anxiety issue(s) </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Many adverse side effects </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Strong cross-activity with other depressants (alcohol) </li></ul></ul></ul></ul>
  28. 28. Dissociative Disorders <ul><li>Dissociative reactions </li></ul><ul><ul><li>Characterized by disruptions in consciousness, memory, or sense of identity (“dissociated”) </li></ul></ul><ul><ul><li>Aspects of experience kept separate in memory </li></ul></ul><ul><ul><li>Psychogenic amnesia or “fugue” </li></ul></ul><ul><li>Dissociative Identity Disorder </li></ul><ul><ul><li>“ Multiple Personality Disorder ” </li></ul></ul><ul><ul><li>At least two separate/distinct personalities exist within the same individual </li></ul></ul>
  29. 29. Personality Disorders <ul><li>Antisocial personality disorder </li></ul><ul><ul><li>“ Without a conscience”, “sociopath”, “psychopath” </li></ul></ul><ul><ul><li>Characterized by those who easily exploit or harm others without guilt or remorse (high intelligence + amorality) </li></ul></ul><ul><ul><li>History of conduct disorder, recklessness, comparatively fearless, lying, stealing, being manipulative, constant absences </li></ul></ul><ul><ul><li>Slightly more common in men (~3%) vs. women (~1%) </li></ul></ul><ul><ul><li>Violent and non-violent differentiation </li></ul></ul>
  30. 30. <ul><li>Narcissistic personality disorder </li></ul><ul><ul><li>Extreme preoccupation with the self and self-promotion </li></ul></ul><ul><ul><li>Symptoms </li></ul></ul><ul><ul><ul><li>Disregard for the feelings of others </li></ul></ul></ul><ul><ul><ul><li>Grandiosity </li></ul></ul></ul><ul><ul><ul><li>Obsessive self-interest </li></ul></ul></ul><ul><ul><ul><li>Pursuit of primarily selfish goals </li></ul></ul></ul><ul><ul><ul><li>Often demand/expect constant attention and admiration </li></ul></ul></ul>Personality Disorders
  31. 31. Therapy <ul><li>Psychotherapy/Psychoanalysis (Freud) </li></ul><ul><ul><li>Disorders stem from conflicts between Id, Superego, and Ego </li></ul></ul><ul><ul><li>Treatment involves communication between patient and a therapist, either individually or in a group </li></ul></ul><ul><ul><li>Make the unconscious conscious </li></ul></ul>
  32. 32. Therapy <ul><li>Humanistic </li></ul><ul><ul><li>Client-centered therapy (Rogers) </li></ul></ul><ul><ul><ul><li>Assumes problems emerge when concept of self is incongruent with actual experiences </li></ul></ul></ul><ul><ul><ul><li>Losing touch with emotions and “inner voice” is what can lead to psychopathology </li></ul></ul></ul><ul><ul><ul><li>Therapist empathizes with patient, demonstrating unconditional positive regard/fundamental acceptance </li></ul></ul></ul><ul><ul><ul><li>Emphasizes the curative value of empathy </li></ul></ul></ul><ul><ul><ul><li>“Empty chair technique” </li></ul></ul></ul>
  33. 33. Therapy <ul><li>Cognitive-behavioral </li></ul><ul><ul><li>An individual’s thoughts determine their behavior, thus distorted thinking leads to “maladaptive schemas” </li></ul></ul><ul><ul><li>Treatment involves identify thoughts that trigger maladaptive emotions </li></ul></ul><ul><ul><li>Cognitive restructuring and behavior modification </li></ul></ul><ul><ul><ul><li>Exposure techniques </li></ul></ul></ul><ul><ul><ul><ul><li>Systematic desensitization </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Aversive conditioning </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Flooding </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Modeling </li></ul></ul></ul></ul>

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