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Mental illness is an equal opportunity threat to success happiness, and contentment in life and can be found among all people of the world irrespective.

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Presentation on theme: "Mental illness is an equal opportunity threat to success happiness, and contentment in life and can be found among all people of the world irrespective."— Presentation transcript:

1 Mental illness is an equal opportunity threat to success happiness, and contentment in life and can be found among all people of the world irrespective of age, race, gender, religion, ancestry, culture, region, social class. You cannot infer personal weakness, bad breeding, a lack of character, or problematic parenting from mental illness. Both genetics and environment are apparent contributing causes for most types of mental disorders. Slide prepared by Dr. Gordon Vessels 2005

2 Mental Health-Illness
Mental health can be described as functioning that results in productive activities, fulfilling relationships, the absence of serious emotional distress and reality distortion, and the resilience to adapt and cope with adversity and change. Mental illness refers to any and all diagnosable mental disorders that (a) are characterized by abnormal thinking, feeling, or behavior and (b) limit or prevent success, comfort, or happiness in one’s personal, social, or professional lives. Slide prepared by Dr. Gordon Vessels 2005

3 What Is Abnormality in Mental Health ???
Three criteria Deviant Maladaptive Causing personal distress A continuum from normal to abnormal The medical model proposes that it is useful to think of abnormal behavior as a disease…Thomas Szasz and others argue against this model, contending that psychological problems are “problems in living,” rather than psychological problems. In determining whether a behavior is abnormal, clinicians rely on the following criteria: 1. Is it deviant, or does it violate societal norms, 2. Is it maladaptive, that is, does it impair a person’s everyday behavior, and 3. Does it cause them personal distress? All three criteria do not have to be met for a person to be diagnosed with a psychological disorder…diagnoses involve value judgments. Antonyms such as normal vs. abnormal imply that people can be divided into two distinct groups, when in reality, it is hard to know when to draw the line. Slide prepared by Dr. Gordon Vessels 2005

4 ABNORMAL NORMAL Deviance Distress/Discomfort Dysfunctional Behavior
The 3 most important defining aspects of abnormality. Deviance NORMAL Distress/Discomfort ABNORMAL Dysfunctional Behavior Three defining aspects of abnormality on a continuum. There is no distinct or specific boundary between normality and abnormality. Behavior, thinking, and emotions are normal or abnormal by degree based on the extent to which actions, thoughts, and feelings are deviant, personally distressing, dysfunctional or maladaptive, and potentially dangerous to self or others. Similar slide retrieved at No author. This slide arranged by Gordon Vessels, 2005.

5 “Ds” Reduced: The 4 ‘D’s Discomfort/ Distress Deviance Dysfunction/
Disability/ Maladaptation Danger Abnormality Defined Slide prepared by Dr. Gordon Vessels 2005

6 “D” Elements of Abnormality
Distress (emotional suffering) Discomfort (social situations) Deviancy I (statistically rare) Deviancy II (in violation of societal standards or norms) Dysfunction (maladaptation to environmental conditions) Danger (to self and/or others due to irrational, unexpected, and unpredictable responses Slide prepared by Dr. Gordon Vessels 2005

7 Concepts of Mental Illness
Mental health concepts This table illustrates how the concepts of mental illness changed from primative times up to the 20th Century Time Period Concepts of Mental Illness Primitive times Evil spirits needed to be driven out Ancient civilizations (Greek and Roman) It was thought to be a natural phenomenon - a relatively scientific and humanistic approach Middle Ages ( in Italy and 1500 in Northern Europe) Supernatural attributions including demon possession, witchcraft, sorcery, and astrology such as the movements of the moon. Renaissance (began in the 14th century in Italy, and in the 16th century in northern Europe) A decline in the belief in demonic possession; mental problems were irreversible; scientific inquiry and humanism make progress. Eighteenth Century Reform - chains removed; need for medical care recognized; the first mentally ill patient was treated rather than abused in a hospital. Nineteenth Century Research began and legislation concerning mental health was enacted; long-term custodial care hospitals were created. Twentieth Century The start of the mental health movement; state hospitals were built; community health care centers established; holistic concept of care and short term care introduced; goal was to return patients to society, so human service programs were established; focus on prevention. Source: an unnamed nursing student, A history of mental health. retrieved at Slide. prepared by Dr. Gordon Vessels 2005

8 Historical reform movements in mental health treatment in the US
Era Setting Focus of Reform More humane; restorative treatment goal Moral Treatment Asylum Mental hospital or clinic More prevention; scientific orientation Mental Hygiene De-institutionalization; social integration of mentally ill Community Mental Health Community mental health center Community support Mental illness as a social welfare problem (e.g., housing, employment) Community Support 1975-present Source: Author not identified (2005). Social Policy and Mental Health, a PPT slide show prepared at the School of Social Welfare at UC Berkeley Slide prepared by Dr. Gordon Vessels 2005

9 Looked inside and outside the body for the causes of mental disorders.
Hippocrates (460 – 370 B.C.) Looked inside and outside the body for the causes of mental disorders. Identified four humors – blood, phlegm, yellow bile, black bile – a balance kept the body in good shape while imbalances caused mental disorders (e.g. excess black bile caused melancholia). Had a typology of personality/ character types that was aligned with these substances – sanguine, choleric, melancholic, phlegmatic. Introduced the terms: melancholia, mania, paranoia, and hysteria. Used phleboctomy, purgatives, diuretics, and hypnotics. “Statue” by Bankster Kovacs; Copied here with the artist’s written permission Source: Fisar, Z. (2003). Introduction, Development of Psychiatry. Retrieved from Slide created by Gordon Vessels, 2005

10 The Biological Tradition (Disease Model)
Hippocrates (450 B.C.): one of the first to consider that psychopathology could be a disease related to body fluids or humors Galen (150 A.D.): extended Hippocrates work hundreds of years later. Humoral Theory = imbalance in 4 humors, e.g., too much black bile was thought to cause depression, referred to as melancholia. The Galenic-Hippocratic Tradition Anticipated current views linking abnormality with brain chemical imbalances, and provided a vocabulary used by physicians for centuries Slide prepared by Dr. Gordon Vessels 2005

11 Slide prepared by Dr. Gordon Vessels 2005 ©
Middle Ages & Beyond Abnormality or deviancy was sadly interpreted as a battle between good and evil After the fall of the Roman Empire, abnormal behavior, thinking, and emotion were thought to be caused by demons, witchcraft, and sorcery. Treatments included exorcism, torture, burnings, beatings, and crude surgeries. Astrological explanations also offered. Lunacy caused by movements of the moon (luna meaning moon) This is not part of current scientific thinking, but even today many people believe in astrology. Painting entitled “When I meet God” by Bankster Kovacs 2004; Copied here from his website with his written permission. /

12 Background painting titled “I am the Doorway” by Steve Saugulis aka t-gar Check out this artist’s work at Used here with written permission Renaissance (1300 to 1699) The belief that mental illness was caused by evil spirits carried into the Renaissance. Paracelsus ( ) did not believe this, but he was unable to change the status quo. The mentally ill were put in prisons and prison-like asylums. Asylums were introduced in the sixteenth century. The word “care” at this time meant removal from society. Lunatics were described as dangerous, defective and incompetent. Their condition was considered irreversible. In 1403 the Bethlem Royal Hospital in London began accepting lunatics. It was infamous for the brutal treatment of patients. Doctors allowed visitors to view lunatics in zoo-like cages. It wasn’t until 1700 that the insane were called “patients.” It was not until the last half of the 18th century that this ended. Source: an unnamed nursing student who wrote, A history of mental health. retrieved at Slide. prepared by Dr. Gordon Vessels 2005

13 The Eighteenth Century
Slide prepared by Dr. Gordon Vessels 2005 © During , Franz Mesmer pioneered a therapeutic approach to behavior. He suggested that the mentally ill could be cured by holding rods filled with iron filings in water. He thought that this gave people balance in the universe. This technique proved to be wrong, but the term "mesmerized" is from Mesmer. Philipe Pinel ( ) removed the chains from 12 patients in Bicetre Hospital in this began a move towards more humane care of patients. Iron rods filled with what? I’m not doing it unless I can hold it in a bucket of your blood, you flat-faced lunatic! The Eighteenth Century Source: an unnamed nursing student who wrote, A history of mental health. Retrieved at Background painting titled “Cannibal” by Steve Saugulis aka t-gar Used here with his written permission. Slide. prepared by Dr. Gordon Vessels 2005

14 Franz Mesmer Coined terms “animal magnetism”
Oh Franzie! You wouldn’t try to have your way with me would you big boy. Franz Mesmer Coined terms “animal magnetism” Cure brought about through transmission of an invisible fluid ??? Psychological rather than physical cause proposed I can’t believe she’s buying this invisible juice nonsense. Slide prepared by Dr. Gordon Vessels 2005

15 Jean Martin Charcot (1825-93)
Tried to solve hysteria puzzle Used hypnosis to treat “hysterical” patients Was Sigmund Freud’s teacher I also won a beauty contest. OK, your right. It was the mule category at the fair, but that doesn’t mean I’m not real pretty. Slide prepared by Dr. Gordon Vessels 2005

16 The 19th Century The discovery of Syphilis (General
Paresis) and its link with “madness” Syphilis causes psychotic symptoms in late stages (delusions, hallucinations). L. Pasteur found the cause – a bacterial microorganism. Penicillin was found to be a successful treatment in 1870. This link reinforced the view that mental illness should be treated like a physical illness. Today the pendulum has swung too far in the direction of seeing mental illness only as a physical illness. This view is held by physicians and not most psychologists. Psychologists acknowledge contributing physical causes but continue to emphasize the role of the environment. Slide prepared by Dr. Gordon Vessels 2005

17 Last half of the 19th century Psychiatric Disorders & Mental Retardation
Slide prepared by Dr. Gordon Vessels 2005

18 Fascism and the World War II Era
law about prevention of hereditable illnesses; 400,000 persons sterilized 1939 – euthanasia permitted; T4 action; 10,000 children murdered – 180,000 psychiatric patients murdered in Germany Fisar, Zdenek (2005). [ Dept. of Psychiatry at Charles University in Prague (Mudr Jiri Raboch, Drsc., Head), Introduction: development of psychiatry. A PPT slide presentation retrieved from Slide prepared by Gordon Vessels, 2005 Art entitled “Monster” is used here with permission from Steve Saugulis aks t-gar. Check out his work at

19 The most popular current perspective about cause is a
Bio-psycho-social view: Most mental disorders develop when a biological or genetic predisposition (a diasthesis) is triggered by stressful environmental events or circumstances. Biological, psychological, and social risk factors all play a role in the development of mental disorders. Slide prepared by Dr. Gordon Vessels 2005

20 Bio-Psycho-Social Model of Abnormal Behavior
Trigger event is a biology film that has lots of blood 16 year old female student Biological Influences inherited over-reactive sinoaortic baroreflex arc Vasovagal syncope: rate and blood pressure increase, body over-compensates Light headedness and queasiness Judy faints Social Influences Behavioral Influences Judy’s fainting causes disruptions in school and at home Friends and family rush to help her Principal suspends her Doctor says nothing is physically wrong Conditioned response to sight of blood: similar situations ─ even words ─ produce same reaction Tendency to escape and avoid situations involving blood Psychological Influence Increased fear and anxiety supporting the diagnosis of an anxiety disorder DISORDER Slide prepared by Dr. Gordon Vessels 2005

21 Perspectives on the Causes of Mental Disorders
Psychodynamic - mental disorders originate in intrapsychic conflict traceable to early childhood experiences. Medical/Biological - mental disorders are caused by specific abnormalities of the brain and nervous system. Cognitive-Behavioral - mental disorders are learned dysfunctional behavior patterns caused by cognitive distortions. Humanistic - mental disorders occur when people are blocked from fulfilling their potential for growth. Sociocultural - mental disorders are shaped by culture, and appear only in certain cultures. Slide prepared by Dr. Gordon Vessels 2005

22 Attitudes on Mental Illness
A recent survey of 650 Harris County residents shows greater empathy and awareness of mental health issues Do you think companies that provide health insurance to their employees should or should not be required to cover mental health treatment in the same way as treatment for other illnesses? Should Should 86% not 6% Don’t know/no answer 8% In your opinion, is mental illness primarily due to . . . Brain Something Disorder Else 63% % Don’t Know/no Character answer flaw 5% How concerned would you be if you discovered that a person being treated for a mental illness was living in your neighborhood? Somewhat Not concerned concerned 33% % Don’t Very know/no concerned Answer 5% % Source: Houston Area Survey (2004) from the Chronicle, a local newspaper Slide prepared by Dr. Gordon Vessels 2005

23 All children face some mental health problems such as the following:
Slide prepared by Dr. Gordon Vessels 2005 Problems dealing with parents & teachers Anxiety about school performance Unhealthy peer pressure Facing tough decisions Developmental adjustment problems School phobia Suicidal ideation Drug or alcohol use Worrying about sexuality Fears about starting school Dealing with death or divorce Feeling depressed or overwhelmed Considering dropping out of school / My Bleeding Doll by MistaBobby; Artwork used here with the artist’s writtenpermission. 2

24 Major Diagnostic Categories
Disorders Usually First Diagnosed in Infancy, Childhood, or Adolescence, e.g., ADHD Substance-related disorders Sexual and Gender Identity Disorders Schizophrenia Mood Disorders Anxiety Disorders Somatoform Disorders Dissociative Disorders Sleep Disorders Eating Disorders Factitious Disorders Adjustment Disorders Impulse-control Disorders Personality Disorders Delirium, Dementia, Amnestic, and Other Cognitive Disorders Classification describes and orders clusters of symptoms Diagnostic & Statistical Manual of Mental Disorders DSM-IV Goals of Classification Describe a disorder Predict its future course Imply appropriate treatment Stimulate research into its cause Slide prepared by Dr. Gordon Vessels 2005

25 Top Ten Principal Causes of Years Lived with Disability in Advanced Countries 1990
Murray and Lopez (1997). Murray, C.J.L. & Lopez, A.D. (Eds) (1996). The Global Burden of Disease. Harvard University Press; Murray, C. J. L. & Lopez, A. (1996) Global Health Statistics: A Compendium of Incidence, Prevalence and Mortality Estimates for over 2000 Conditions. Cambridge: Harvard School of Public Health. Fisar, Zdenek (2005). [ Dept. of Psychiatry at Charles University in Prague (Mudr Jiri Raboch, Drsc., Head), Introduction: development of psychiatry. A PPT slide presentation retrieved from Slide prepared by Gordon Vessels, 2005.

26 Common and Uncommon Phobias Percentage of people surveyed
100 90 80 70 60 50 40 30 20 10 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 Fisar, Zdenek (2005). [ Dept. of Psychiatry at Charles University in Prague (Mudr Jiri Raboch, Drsc., Head), Introduction, development of psychiatry. A PPT slide presentation retrieved from Slide prepared by Gordon Vessels, 2005.

27 Common Obsessions and Compulsions Among People with
Obsessive-Compulsive Disorder (OCD), an Anxiety Disorder Percentage Reporting Symptom Type of Obsession or Compulsion Obsessions (repetitive thoughts) Concern with dirt, germs, or toxins (e.g. Howard Hughes) 40 Something terrible happening (fire, death, illness, rape, injury Symmetry, order, exactness, neatness (“neat freaks”; perfectionists) Compulsions (repetitive behaviors) Excessive hand washing, bathing, tooth brushing, or grooming Repeating rituals (in/out of door, avoiding cracks in sidewalk) Checking doors, locks, car brake, homework, children, etc Slide prepared by Dr. Gordon Vessels 2005

28 Depression: Men compared to Women
20 15 10 5 Around the world women are more susceptible to depression Percentage of population aged Experiencing major depression at some point in life USA Canada Puerto France West Italy Lebanon Taiwan Korea New Rico Germany Zealand 2 Kessler, R. et al. (1995) Archives of General Psychiatry; Volume 52: Slide prepared by Dr. Gordon Vessels 2005

29 Co-morbidity in Post Traumatic Stress Disorder, i. e
Co-morbidity in Post Traumatic Stress Disorder, i.e. other disorders suffered by those with PTSD Male 60 Female 50 40 Comorbidity (%) 30 20 10 Major Depressive Episode Gen. Anxiety Disorder Panic Disorder Social Anxiety Disorder Agora phobia Alcohol Abuse Drug Abuse/ Dependence Kessler R. et al. (1995). Archives of General Psychiatry. 52: Slide prepared by Dr. Gordon Vessels 2005

30 Prevalence of Trauma and Related Probability of PTSD
40 1 Male Prevalence of Trauma Female 30 % 20 10 Threat w/ Weapon Physical Attack Witness Accident Molestation Combat Rape 70 Probability of Post Traumatic Stress Disorder 2 60 50 % 40 30 20 10 Threat w/ Weapon Physical Attack Witness Accident Molestation Combat Rape 1 Kessler, R. et al. (2000) Journal of Clinical Psychiatry, Volume 61(Suppl 5):4-14. 2 Kessler, R. et al. (1995) Archives of General Psychiatry; Volume 52: Slide prepared by Dr. Gordon Vessels 2005

31 Prevalence of Mental Disorders
Proportion of Population with Mental Disorders During Lifetime Disorder Type Any Disorder Substance Abuse Anxiety Disorders Mood Disorders Schizophrenia Prevalence of Mental Disorders Estimated percentage of people who have suffered mental disorders during their lives. The estimates are based on the Epidemiological Catchment Area studies and the National Co-morbidity Study, as summarized by Regier and Burke (2000) and Dew, Bromet, and Switzer (2000). Slide prepared by Dr. Gordon Vessels 2005

32 Positron emission tomography (PET) produces scanned images of the
human brain. Schizophrenia Normal Red, pink, and orange indicate lower levels of brain activation; white and blue indicate higher activation levels. Activity in the schizophrenic’s brain is low in the frontal lobes, which is at the top (Velakoulis & Pantelis, 1996). Activity in the manic-depressive’s brain is low in the left hemisphere and high in the right hemisphere. The reverse is usually true for schizophrenics. Researchers are finding consistent patterns that will aid in diagnosing mental disorders. Manic-Depression Slide prepared by Dr. Gordon Vessels 2005

33 Risk of Schizophrenia 48% 46% 17% 17% 9% 1%
Contributing genetic cause – the hereditability Index is high Schizophrenia for relatives of a schizophrenic Lifetime risk of developing 17% 17% 9% 1% General population Siblings Children of one schizophrenic Fraternal twin Children of two schizophrenics Identical twin Sources: Lenzenweger, Mark F. and Dworkin, Robert H., Editors (1989 Origins and Development of Schizophrenia : Advances in Experimental Psychopathology; Gottesman, Irving I. and Moldin, Stephen O. (1998). Genotypes, genes, genesis, and pathogenesis in schizophrenia (first chapter in the former). Slide by Vessels 2005

34 Symptoms of Schizophrenia
The severity of symptoms varies from one person to another, and, typically, symptoms will decline and then reappear. Symptoms are divided into Positive and Negative. Artwork entitled “Duality” is by Steve Saugulis aka t-gar is used here with the permission of the artist. Check out his artwork at Slide prepared by Dr. Gordon Vessels 2005

35 Dimensions Schizophrenia
Positive Symptoms vs Negative Symptoms disorganized/deluded vs toneless/expressionless inappropriate emotions vs silence/catatonia Chronic vs Acute Schizophrenia slow development/history of social inadequacy vs rapid development/reaction to specific life stress Slide prepared by Dr. Gordon Vessels 2005

36 “Positive” and “Negative” Symptoms of Schizophrenia
Positive symptoms include abnormal thoughts, perceptions, language, and behavior. • Delusions: false beliefs/thoughts with no basis in reality Hallucinations: disturbances of perception (hearing, seeing, or feeling things not there) Disorganized Thinking/Speech: jumping from topic to topic, responding to questions with unrelated answers, or speaking incoherently with loosely associated thoughts Disorganized Behavior: problems in performing routine daily activities Catatonic Behavior: lowered environmental awareness and responsiveness; rigid and/or inappropriate postures; resistance to movement or instructions. Negative symptoms include the constricted range and intensity of emotional expression and communication, strange body language, and reduced interest in normal activities. Blunted (or flat) Affect: decreased emotional expressiveness; unresponsive immobile facial appearance; reduced eye contact Alogia: reduced speech; responses detached; dysfluent speech Avolition: lacking motivation, spontaneity, or initiative; sitting for lengthy periods or ceasing to participate in work or daily activities Anhedonia: lacking pleasure or interest in activities that were once enjoyable Attention Deficit: difficulty concentrating Slide prepared by Dr. Gordon Vessels 2005

37 Brain Abnormalities Schizophrenia: Still Searching for Causes
Reconstructing Venus by Shelley Bergen aka Nebu is used here with the written permission of the artist. Schizophrenia: Still Searching for Causes Understanding Brain Abnormalities More dopamine receptors or more sensitive receptors; Less active in frontal lobe areas; Low activity in frontal lobes; Enlarged cerebral ventricles and/or smaller limbic area Neurodevelopmental causation, meaning multiple causes: Genetics or a genetic predisposition could play a slightly more important causal role than environmental factors such as stressful experiences, poor early nutrition or illness, and a lack of expressed emotion in the family. 1 in 100 for the general population 1 in 10 chance if a sibling or parent is schizophrenic 1 in 2 chance if identical twin is schizophrenic or if both parents are schizophrenic Slide prepared by Dr. Gordon Vessels 2005

38 There is no one cause to this complex and puzzling illness,
but it is thought that a combination of genetics, biology (virus, bacteria, or an infection) and stressors in life all play a role. Except for the odds for an identical twin of a schizophrenic or the child of two, there is currently no reliable way to predict whether a person will develop this serious mental disorder. “Into the Depths” by Shelley Bergen aka Nebu is used here with her written permission. Slide prepared by Dr. Gordon Vessels 2005

39 John Nash is now a famous
Aftermath by Psychosomatks (Garetha Botha) is used here with the artist’s written permission. John Nash is now a famous Schizophrenic. His life story was made into a film, A Beautiful Mind. Slide prepared by Dr. Gordon Vessels 2005

40 Subtypes of Schizophrenia
Slide prepared by Dr. Gordon Vessels 2005 Subtypes of Schizophrenia Paranoid: Delusions of grandeur or persecution and hallucinations Disorganized: Disorganized speech (too vague, abstract , repetitive, unelaborated, impoverished in content; flat, blunted, or inappropriate emotion; loosely associated thoughts Catatonic: Ranging from rigidly immobile to wildly hyperactive Undifferentiated Symptoms include those above but symptoms as a whole or Residual do not fit one of the above types; residual means previously schizophrenic with mild carryover symptoms Nerida by MistaBobby; Artwork used here with the artist’s permission.

41 Disorganized Thinking
Slide prepared by Dr. Gordon Vessels 2005 © Self-Purification by Mista Bobby (Sychophant13X) Disorganized Thinking Delusions Thinking is fragmented and distorted by false beliefs – typically about self and imagined threats to self. Breakdown in selective attention leaves the person easily distracted. “This morning when I was at Hillside (hospital), I was making a movie. I was surrounded by movie stars. The security guard was Don Knotts. That Indian doctor in building 40 was Lou Costello. I’m Mary Poppins. Is this room painted blue to get me upset?” “Original Sin” by MistaBobby; Artwork used here with the artist’s written permission.

42 Presynaptic Axon Terminal Postsynaptic Dendrite
Dopamine normally crosses the synapse between two neurons, activating the second cell. Antipsychotic Drug Presynaptic Axon Terminal Postsynaptic Dendrite Receptor Site Dopamine Synaptic Vesicle Antipsychotic drugs bind to the same receptor sites as dopamine thus blocking its action. For schizophrenics, a reduction in dopamine activity can quiet agitation and psychotic symptoms. Synaptic Gap Slide prepared by Dr. Gordon Vessels 2005

43 Slide prepared by Dr. Gordon Vessels 2005
Mood Disorders Artwork entitled “Disgarded” by Steve Saugulis aka t-gar is used here with the artist’s permission; check out this artist’s work at

44 Symptoms of Depression
Frequent or excessive crying Persistent sad, empty, dysphoric, or irritable mood and anger (the latter two common for children) Loss of interest in activities once enjoyed (“anhedonia) Recurring thoughts of death, suicide, and self-harm; possible suicide attempts (adults and teens) Diminished ability to concentrate and make decisions Feelings of hopelessness, helplessness, worthlessness; guilt misattributed to self; low self-esteem Poor or excessive appetite resulting in weight loss or gain Insomnia or hypersomnia (constant sleep) Fatigue, lethargy, loss of energy, lack of motivation, complacency Psychomotor agitation or retardation; headaches and stomach aches among children Chronic aches and pains Types of Depression Mood Disorders Major Depressive Disorder: experience prolonged hopelessness and lethargy, sad or dysphoric mood, etc. Bipolar Disorder or Manic-Depression: alternating between depression and mania (an overexcited and hyperactive state) Other forms of depression: Dysthymia, a chronic depressed mood; Abnormal Bereavement; Adjustment Disorder with Depressed Mood; Depressive Personality Disorder; Depressive Disorders NOS Slide prepared by Dr. Gordon Vessels 2005

45 SSRI medications increase serotonin,
The neurotransmitter SEROTONIN is low when a person is depressed. This causes body changes: Pain Threshold Lowered: depressed people often feel more pain with no apparent cause. Back pain is very common among sufferers. Sleep Disturbance: the day of a depressed person runs on an average of 22 hours, not 24. There are spikes in body temperature throughout the night that cause a person to wake and not get enough REM sleep. SSRI medications increase serotonin, increase activity, lift depression, and may alter hormonal activity as well activity. Slide prepared by Dr. Gordon Vessels 2005

46 How SSRIs work to reduce the symptoms of depression and anxiety.
Neurotransmitters are held in sacs at the end of the nerve cell. An electrical signal causes the sacs to merge with the membrane causing the neurotransmitter to be released into the synapse. Molecules moves across the gap and bind receptors, which are special proteins, on the adjacent nerve cell or neuron. When enough neurotransmitters have been absorbed, the receptors release the molecules. They are then broken or re-absorbed by the initial neuron and stored away for future use. Prozac, Paxil, Zoloft, and other SSRIs enhance the affect of serotoninby preventing it from being absorbed (called re-uptake). Redux and other anti-obesity drugs increase serotonin. There are at least 15 different serotonin receptors, each with a different function Slide prepared by Dr. Gordon Vessels 2005

47 not because of their lack of control over environmental
Slide prepared by Dr. Gordon Vessels 2005 Stressful situations can help cause depression, but environmental stressors are more important causes for some types of depression than others. The environment is least important with Bipolar Disorder, more important for Major Depression and Dysthymia, and definitive for Adjustment Disorder with Depressed Mood. But there is an intervening personality factor that determines how we respond to stressors — related to Rotter’s attribution theory of motivation. Some people become depressed not because of their lack of control over environmental stressors but because of the way they habitually explain good and bad events to themselves. This explanatory style serves us or disserves as a mediator thereby determining if we experience helplessness and suffer depression There are three dimensions to explanatory style: permanent versus temporary, universal versus specific, and internal versus external. An internal attribution or explanation means one blames themselves rather than forces out of their control. If a person’s explanation of a failure or problem is universal, she over-generalizes and gives up quickly. Self-explanations that see situations as permanent make one more vulnerable. This is a detailed description of being pessimistic, perhaps with good reason, or optimistic. Astral Blessings by by MistaBobby; Artwork used here with the artist’s permission.

48 Slide prepared by Dr. Gordon Vessels 2005
25 20 15 10 5 Rate Per 100,000 Population Data for 1933 through Youth in Age Range

49 Description (18 or older and multi-year pattern)
Personality Disorder Description (18 or older and multi-year pattern) Paranoid Suspiciousness, guarded, tense; extreme distrust of others; perception of being under attack; hold grudges Obsessive- compulsive Preoccupation with rules and order; inflexible; stiff; indecisive; perfectionististic tendencies; difficulty enjoying life. Histrionic Attention-seeking; preoccupation with attractiveness; anger when attention seeking fails; highly dramatic, seductive, pretentious; over-value and devalue relationships; rapidly changing moods. Borderline Lack of impulse control; drastic mood swings; sudden anger; intense unstable relationships; can’t stand to be alone; instability in behavior, emotion, identity, self-esteem, friendships, etc. Avoidant Oversensitivity to rejection; no confidence in initiating and maintaining social relationships; easily hurt or embarrassed; few close friends; sticks to routines to avoid new contacts. Dependent Uncomfortable being alone; places others’ needs above one’s own to preserve relationships; wants others to make decisions; wants to be cared for; submissive. Antisocial Once called psychopathic or sociopathic; remorseless, selfish, reckless, deceitful, manipulative, lawbreaking, impulsive. Narcissistic Self-absorbed; expects special treatment and adulation; exaggerated opinion of self; poor perspective taking ability Schizotypal Peculiarities of speech, perceptions, appearance, and behavior that unsettle others; emotionally detached and socially isolated. Schizoid Not interested in relationships; indifferent to praise or criticism; restricted range of emotions (relatively flat affect). Slide prepared by Dr. Gordon Vessels 2005 ©

50 ANXIETY DISORDERS Approximately 20 to 30% of people experience an anxiety disorder. Generalized Anxiety Disorder: A tense, uneasy, and apprehensive feeling that is unexplainable and unavoidable because the cause can’t be identified. May develop into “Panic Attacks.” Adjustment Disorder with Anxious Mood results from a fear producing psychosocial environmental stressor and Ends when the stressor is go Obsessive-Compulsive Disorder: Obsessions, or recurring and unwanted thoughts, impulses, and mental images are usually connected with behavioral compulsions that only temporarily relieve anxiety. If not performed, the person is left with unbearable anxiety. Obsessions are unwanted thoughts; compulsions are behaviors the person can’t stop performing when they are known to be irrational and sure to preclude happiness. Panic Attacks: recurring and unpredictable psychophysiological symptoms that appear in the absence of an emergency that bring sweating, shaking, racing heartbeat, fear of dying, and the feeling of totally losing control. Once experienced, it brings on a fear of fear because the experience is so intense. This can lead to the diagnosis of Panic Disorder. Posttraumatic Stress Disorder (PTSD) results from experiencing or witnessing life threatening events that brought fear, horror, and helplessness. These events are then re-experienced vividly through recollections or dreams, or by reacting physically and emotionally to cues of the event. Plagued by increased arousal and a fear of reliving the event, the victim builds defenses that interfere with normal social and occupational functioning. Phobic Disorders: irrational fear of a specific object or situation that is out of proportion to the real danger. People often accept and live with phobias. Fear of snakes, high places, crowds, public speaking, cats, etc. Social phobia is referred to as Social Anxiety Disorder. Separation Anxiety Disorder: child cannot separate from Mother without suffering extreme distress. Slide prepared by Dr. Gordon Vessels 2005 This work of art entitled “The Compounded” is by Gareth Botha aks Psychosomatiks. It is used here with permission.

51 There are many other diagnoses in the DSM-IV
There are many other diagnoses in the DSM-IV. The chart here and on the next few slides lists many of them. Click on the links and learn more. Dementia of the Alzheimer’s Type, With Late Onset, Uncomplicated Dementia due to Pick's Disease Dementia due to Creutzfeld-Jacob disease Dementia of the Alzheimer’s Type, With Early Onset, Uncomplicated Dementia of the Alzheimer’s Type, With Early Onset, With Delirium Dementia of the Alzheimer’s Type, With Early Onset, With Delusions Dementia of the Alzheimer’s Type, With Early Onset, With Depressed Mood Dementia of the Alzheimer’s Type, With Late Onset, With Delusions Dementia of the Alzheimer’s Type, With Late Onset, With Depressed Mood Dementia of the Alzheimer’s Type, With Late Onset, With Delirium Hallucinogen Persisting Perception Disorder (Flashbacks) Schizophrenia, Disorganized Type Schizophrenia, Catatonic Type Schizophrenia, Paranoid Type Schizophreniform Disorder Schizoaffective Disorder Bipolar I Disorder Single Manic Episode Slide prepared by Dr. Gordon Vessels 2005

52 There are many other diagnoses in the DSM-IV
There are many other diagnoses in the DSM-IV. The chart found here and on the next few slides list many of them. Click on the links and learn more. Anxiety Disorder Due to General Medical Condition Mood Disorder Due to General Medical Condition Dementia Due to Head Trauma Major Depressive Disorder Single Episode Major Depressive Disorder Recurrent Bipolar I Disorder Most Recent Episode Hypomanic Bipolar I Disorder Most Recent Episode Manic Bipolar I Disorder Most Recent Episode Depressed Bipolar I Disorder Most Recent Episode Mixed Bipolar II Disorder Delusional Disorder Shared Psychotic Disorder Brief Psychotic Disorder Autistic Disorder Childhood Disintegrative Disorder Rett's Disorder Asperger's Disorder Slide prepared by Dr. Gordon Vessels 2005

53 There are many other diagnoses in the DSM-IV
There are many other diagnoses in the DSM-IV. The chart found here and on the next few slides list many of them. Click on the links and learn more. Pervasive Developmental Disorder NOS Anxiety Disorder NOS Panic Disorder Without Agoraphobia Generalized Anxiety Disorder Conversion Disorder Dissociative Amnesia Dissociative Fugue Dissociative Identity Disorder Dissociative Disorder NOS Panic Disorder With Agoraphobia Agoraphobia Without History of Panic Disorder Social Phobia Specific Phobia Obsessive-Compulsive Disorder Dysthymic Disorder Somatoform Disorder Paranoid Personality Disorder Slide prepared by Dr. Gordon Vessels 2005

54 There are many other diagnoses in the DSM-IV
There are many other diagnoses in the DSM-IV. The chart found here and on the next few slides list many of them. Click on the links and learn more. Cyclothymic Disorder Schizoid Personality Disorder Schizotypal Personality Disorder Obsessive-Compulsive Personality Disorder Histrionic Personality Disorder Dependent Personality Disorder Antisocial Personality Disorder Narcissistic Personality Disorder Avoidant Personality Disorder Borderline Personality Disorder Pedophilia Transvestic Fetishism Exhibitionism Gender Identity Disorder NOS Gender Identity Disorder in Children or Gender Identity Disorder NOS Gender Identity Disorder in Adolescents or Adults Anorexia Nervosa Slide prepared by Dr. Gordon Vessels 2005

55 There are many other diagnoses in the DSM-IV
There are many other diagnoses in the DSM-IV. The chart found here and on the next slide list many of them. Click on the links and learn more. Tic Disorder NOS Tourette's Disorder Sleep Terror Disorder Sleepwalking Disorder Acute Stress Disorder Adjustment Disorder With Depressed Mood Separation Anxiety Disorder Adjustment Disorder With Anxiety Adjustment Disorder With Mixed Anxiety and Depressed Mood Adjustment Disorder With Disturbance of Conduct Adjustment Disorder With Mixed Disturbance of Emotions and Conduct Posttraumatic Stress Disorder Impulse-Control Disorder NOS Kleptomania Intermittent Explosive Disorder Conduct Disorder Oppositional Defiant Disorder Slide prepared by Dr. Gordon Vessels 2005

56 There are many other diagnoses in the DSM-IV
There are many other diagnoses in the DSM-IV. The chart found here and on the previous slides list many of them. Click on the links and learn more. Disruptive Behavior Disorder NOS Selective Mutism Identity Problem Reactive Attachment Disorder of Infancy or Early Childhood Attention-Deficit/Hyperactivity Disorder Predominantly Inattentive Type Attention-Deficit/Hyperactivity Disorder Combined Type Attention-Deficit/Hyperactivity Disorder Predominantly hyperactive-Impulsive Type Narcolepsy Adult Antisocial Behavior Child or Adolescent Antisocial Behavior Malingering Bereavement Pathological Gambling Enuresis (Not Due to a General Medical Condition) Encopresis Without Constipation and Overflow Incontinence Feeding Disorder of Infancy or Early Childhood Pica Slide prepared by Dr. Gordon Vessels 2005


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