1. Introduction to Psychology, 7th Edition, James W. Kalat Chapter 16: Specific Disorders and Treatments Chapter 16 Specific Disorders and Treatments

2. Introduction to Psychology, 7th Edition, James W. Kalat Chapter 16: Specific Disorders and Treatments Progress in Abnormal Psychology l The growth of understanding of mental disorders and their treatment has paralleled the progress of medical science. l Although we have much yet to learn, we now can make accurate distinctions between a wide range of disorders and we can tailor treatments to meet the needs of those suffering from specific disorders.

3. Introduction to Psychology, 7th Edition, James W. Kalat Chapter 16: Specific Disorders and Treatments Module 16.1 l Anxiety and Avoidance Disorders

4. Introduction to Psychology, 7th Edition, James W. Kalat Chapter 16: Specific Disorders and Treatments Disorders Characterized by Excessive Anxiety l Anxiety refers to a certain amount of fear and caution in the face of potential hazards. n A certain amount of anxiety is normal. n Anxiety is considered pathological when it interferes with daily functioning.

5. Introduction to Psychology, 7th Edition, James W. Kalat Chapter 16: Specific Disorders and Treatments Disorders Characterized by Excessive Anxiety l Generalized anxiety disorder n Generalized anxiety disorder (GAD) is the experience of almost constant and exaggerated worry. m There is no basis for the worries but the person is tense, irritable and tired. m About 5% of the general population will experience GAD. m Often it is co-diagnosed with other mood disorders such as depression.

6. Introduction to Psychology, 7th Edition, James W. Kalat Chapter 16: Specific Disorders and Treatments Disorders Characterized by Excessive Anxiety l Panic disorder n Panic disorder (PD) is characterized by frequent periods of anxiety and occasional attacks of panic. m Panic attacks involve rapid breathing, increased heart rate, chest pains, sweating, trembling and faintness. m Panic attacks usually last just a few minutes, but can be much longer.

7. Introduction to Psychology, 7th Edition, James W. Kalat Chapter 16: Specific Disorders and Treatments Disorders Characterized by Excessive Anxiety l Panic disorder n Panic disorder is experienced by 1-3% of adults and occurs in many cultures. n More women than men are diagnosed with Panic Disorder. n Hyperventilation, or rapid deep breathing, is a key symptom.

8. Introduction to Psychology, 7th Edition, James W. Kalat Chapter 16: Specific Disorders and Treatments Disorders Characterized by Excessive Anxiety l Panic disorder n Hyperventilation causes the body to react as if suffocation were occurring. n The person’s subjective interpretation of the symptoms of hyperventilation can cause an increase in panic or a calming down. n People with panic disorder tend to interpret these episodes as uncontrollable and life threatening. n The constant anxiety they experience increases the likelihood of further panic attacks.

9. Introduction to Psychology, 7th Edition, James W. Kalat Chapter 16: Specific Disorders and Treatments Disorders Characterized by Excessive Anxiety l Panic disorder n Treatments for panic disorder include: m Psychotherapy m Anti-depressant drugs m Advice: “Don’t worry about panic attacks; they won’t kill you.”

10. Introduction to Psychology, 7th Edition, James W. Kalat Chapter 16: Specific Disorders and Treatments Disorders Characterized by Excessive Anxiety l Panic disorder n Common co-existing disorders include: m Social phobia – severe avoidance of other people and fear of doing anything in public. m Agoraphobia – an intense fear of open or public places.

11. Introduction to Psychology, 7th Edition, James W. Kalat Chapter 16: Specific Disorders and Treatments Disorders Characterized by Excessive Anxiety l Phobias n Avoidance behaviors are highly resistant to extinction. n Phobia is the most common type disorder involving avoidance behaviors. n A phobia is strong and persistent fear of a specific object or situation – so strong it interferes with daily living.

12. Introduction to Psychology, 7th Edition, James W. Kalat Chapter 16: Specific Disorders and Treatments Disorders Characterized by Excessive Anxiety l Phobias n The Prevalence of Phobias m Not all extreme fears qualify as phobias. m About 11% of U.S. adults suffer from a phobia at some point in their lives. m About 5-6% are experiencing a phobia at any given time. m Phobia usually does not persist across the lifetime – many young adults lose them by middle age.

13. Introduction to Psychology, 7th Edition, James W. Kalat Chapter 16: Specific Disorders and Treatments Figure 16.2 Most phobias do not last a lifetime. Young people with phobias often lose them by middle age.

14. Introduction to Psychology, 7th Edition, James W. Kalat Chapter 16: Specific Disorders and Treatments Disorders Characterized by Excessive Avoidance l Phobias n Acquiring a phobia: m Some fears are innate but many are learned. m Some phobias can be traced to a specific event. m The early behaviorists were the first to demonstrate how fears might be learned. m This does not account for the fact that some phobias are much more common and easily acquired than others.

15. Introduction to Psychology, 7th Edition, James W. Kalat Chapter 16: Specific Disorders and Treatments Disorders Characterized by Excessive Avoidance l Phobias n The most common phobias include: m Open spaces m Closed spaces m Heights m Lightening and thunder m Certain animals – (snakes, spiders, dogs) m Illnesses/germs

16. Introduction to Psychology, 7th Edition, James W. Kalat Chapter 16: Specific Disorders and Treatments Figure 16.4 A lab-reared monkey learns to fear snakes from the reactions of a wild-reared monkey. But if the snake is not visible, the lab-reared monkey fails to learn any fear.

17. Introduction to Psychology, 7th Edition, James W. Kalat Chapter 16: Specific Disorders and Treatments Figure 16.4 A lab-reared monkey learns to fear snakes from the reactions of a wild-reared monkey. But if the snake is not visible, the lab-reared monkey fails to learn any fear.

18. Introduction to Psychology, 7th Edition, James W. Kalat Chapter 16: Specific Disorders and Treatments Figure 16.4 A lab-reared monkey learns to fear snakes from the reactions of a wild-reared monkey. But if the snake is not visible, the lab-reared monkey fails to learn any fear.

19. Introduction to Psychology, 7th Edition, James W. Kalat Chapter 16: Specific Disorders and Treatments Disorders Characterized by Excessive Avoidance l Phobias n Behavior therapy for phobias m Systematic desensitization – reduces fear by gradually exposing people to the object under controlled conditions. Virtual reality is now being employed for this kind of therapy. m Flooding or implosion – a sudden and large-scale exposure to the object under controlled conditions.

20. Introduction to Psychology, 7th Edition, James W. Kalat Chapter 16: Specific Disorders and Treatments Disorders Characterized by Excessive Avoidance l Phobias n Drug therapies for phobias and anxieties m Benzodiazepines, a common type of tranquilizer, are often prescribed for anxiety disorders. m They suppress symptoms only temporarily and can be addictive. m Anti-depressants, which are not likely to be taken habitually, are used more effectively.

21. Introduction to Psychology, 7th Edition, James W. Kalat Chapter 16: Specific Disorders and Treatments Disorders Characterized by Excessive Avoidance l Obsessive-compulsive disorder n There are two distressing symptoms that comprise obsessive-compulsive disorder. m Obsessions are repetitive, unwelcome streams of thought. m Compulsions are repetitive, almost irresistible actions. m Obsessive thoughts generally lead to compulsive actions. m Checking and cleaning are two very common compulsive behaviors.

22. Introduction to Psychology, 7th Edition, James W. Kalat Chapter 16: Specific Disorders and Treatments Disorders Characterized by Excessive Avoidance l Obsessive-compulsive disorder n Therapies for obsessive-compulsive disorder: m Exposure therapy is very similar to systematic desensitization. m The patient is exposed to the situation that brings on the compulsive behavior, but is prevented from engaging in it. m The most common drug treatments for this disorder utilize clomipramine and other serotonin reuptake inhibiters.

23. Introduction to Psychology, 7th Edition, James W. Kalat Chapter 16: Specific Disorders and Treatments Anxieties and Avoidance l Phobias and anxiety disorders involve the interaction and influence of cognition and emotion upon each other. l People who suffer from these conditions are aware that their reactions are exaggerated, but this awareness doesn’t cure the problem. l These disorders are challenging but psychologists continue to improve the efficacy of available treatments.

24. Introduction to Psychology, 7th Edition, James W. Kalat Chapter 16: Specific Disorders and Treatments Module 16.2 l Substance-Related Disorders

25. Introduction to Psychology, 7th Edition, James W. Kalat Chapter 16: Specific Disorders and Treatments Substance Dependence (Addiction) l Individuals who find it difficult or impossible to quit a dangerous habit are said to have an addiction to it or a dependence on it. l People vary widely in how this affects their daily lives and functioning.

26. Introduction to Psychology, 7th Edition, James W. Kalat Chapter 16: Specific Disorders and Treatments Substance Dependence (Addiction) l Nearly all addictive drugs stimulate the dopamine receptors in the nucleus accumbens. l Activation of these synapses causes increased attention. l This activation is accompanied by feelings of great pleasure.

27. Introduction to Psychology, 7th Edition, James W. Kalat Chapter 16: Specific Disorders and Treatments Substance Dependence (Addiction) l There are two symptoms involved in the development of a drug addiction. n Tolerance – decreased effects of a given dose. n Withdrawal – unpleasant sensations when the drug is not used (or too little is used given the development of tolerance). n Activities and substances that are not drugs can produce addictions – suggesting that addiction is a function of the person, not the drug alone.

28. Introduction to Psychology, 7th Edition, James W. Kalat Chapter 16: Specific Disorders and Treatments Substance Dependence (Addiction) l Is substance dependence a disease? n It depends in part on how we define “disease.” n Psychologists currently favor the use of continuum from “no addiction” to “severe addiction.”

29. Introduction to Psychology, 7th Edition, James W. Kalat Chapter 16: Specific Disorders and Treatments Substance Dependence (Addiction) l Nicotine dependence n Cigarette smoking is based on nicotine addiction. n People are generally able to quit smoking more easily if they have a replacement source of nicotine (i.e. a patch). n Low-nicotine/low-tar cigarettes do not help people to quit.

30. Introduction to Psychology, 7th Edition, James W. Kalat Chapter 16: Specific Disorders and Treatments Figure 16.7 “Low-nicotine” cigarettes have a row of small holes in the filter; room air is supposed to enter through those holes when the smoker inhales and therefore dilute the tobacco smoke. If people smoke such cigarettes without covering the air holes, little tar and nicotine pass through the cigarette, as we see from the relatively clean filter tip. However, if people cover the holes with their fingers or tape, they will receive about as much tar and nicotine as they would from any other filtered cigarette.

31. Introduction to Psychology, 7th Edition, James W. Kalat Chapter 16: Specific Disorders and Treatments Substance Dependence (Addiction) l Alcoholism n Alcoholism is defined as the habitual overuse of alcohol. n Treatment of chronic alcoholism is very difficult. n In order for treatment of alcoholism to be effective, we need to detect the problem in its early stages. n We need to identify the factors that put certain people at risk.

32. Introduction to Psychology, 7th Edition, James W. Kalat Chapter 16: Specific Disorders and Treatments Substance Dependence (Addiction) l Alcoholism n Type I alcoholism develops gradually over the lifespan. n It is equally prevalent in men and women. n It is generally less severe in its health consequences. n Type II alcoholism has an early onset. n It is much more prevalent in men and more severe.

33. Introduction to Psychology, 7th Edition, James W. Kalat Chapter 16: Specific Disorders and Treatments Table 16.3 Type I and Type II alcoholism

34. Introduction to Psychology, 7th Edition, James W. Kalat Chapter 16: Specific Disorders and Treatments Substance Dependence (Addiction) l Alcoholism: Risk factors n Research studies indicate that tendency to addiction is influenced by genetics. n Type II alcoholism shows a strong genetic basis. n Some people with no family history of alcoholism develop an alcohol problem.

35. Introduction to Psychology, 7th Edition, James W. Kalat Chapter 16: Specific Disorders and Treatments Substance Dependence (Addiction) l Alcoholism: Risk factors n Exposure to parental conflict, inadequate supervision, and abuse can increase the likelihood of alcoholism emerging later in life. n Culture also has an influence – prevalence rates vary in different nations and ethnic groups.

36. Introduction to Psychology, 7th Edition, James W. Kalat Chapter 16: Specific Disorders and Treatments Substance Dependence (Addiction) l Treatment for alcoholism n It is very difficult for most people to quit alcohol and the other drugs. n Only 10-20% are successful and relapses are very common. n Many recovering addicts seek help from mental-health professionals or self-help groups. n Such help improves the chances of successful recovery, but offers no guarantees.

37. Introduction to Psychology, 7th Edition, James W. Kalat Chapter 16: Specific Disorders and Treatments Substance Dependence (Addiction) l Treatments for alcoholism n Detoxification is a program of supervised recovery provided in a hospital setting. n Outpatient mental-health treatment has about the same rate of success as detoxification.

38. Introduction to Psychology, 7th Edition, James W. Kalat Chapter 16: Specific Disorders and Treatments Substance Dependence (Addiction) l Treatments for alcoholism n The most widespread treatment for alcoholism is offered by Alcoholic Anonymous (AA). n AA is a self-help group comprised of people who abstain from alcohol use and offer help and support to each other.

39. Introduction to Psychology, 7th Edition, James W. Kalat Chapter 16: Specific Disorders and Treatments Substance Dependence (Addiction) l Treatments for alcoholism n Antabuse is the trade name for disulfiram. n Alcoholics who take Antabuse daily become very sick when they drink alcohol. n This treatment is only moderately effective.

40. Introduction to Psychology, 7th Edition, James W. Kalat Chapter 16: Specific Disorders and Treatments Substance Dependence (Addiction) l Treatments for alcoholism n Controlled drinking refers to reducing consumption of alcohol from dependent/abusive to moderate levels. n Some physicians believe that abstinence is workable for all alcoholics and believe this is a viable alternative. n Harm reduction is a similar approach applied to drug abuse. n These methods are highly controversial

41. Introduction to Psychology, 7th Edition, James W. Kalat Chapter 16: Specific Disorders and Treatments Substance Dependence (Addiction) l Opiate dependence n A very difficult withdrawal syndrome complicates recovery from dependence on opiate drugs (i.e. heroin, morphine). n Some opiate addicts go “cold turkey” in order to stop using.

42. Introduction to Psychology, 7th Edition, James W. Kalat Chapter 16: Specific Disorders and Treatments Substance Dependence (Addiction) l Opiate dependence n Recovery programs commonly offer methadone as a less dangerous replacement for opiates. n This is a harm reduction strategy that allows recovering opiate addicts to remain employed and avoid criminal behavior.

43. Introduction to Psychology, 7th Edition, James W. Kalat Chapter 16: Specific Disorders and Treatments Table 16.4 Comparison of methadone with morphine

44. Introduction to Psychology, 7th Edition, James W. Kalat Chapter 16: Specific Disorders and Treatments Substances, the Individual, and Society l How we handle the problem of substance dependence and abuse in our society remains an area of intense debate. l Our current strategies have not eliminated widespread use. l As a citizen, you may be called upon to think about these issues and help to shape changes in our national drug policy. As you have learned, there are complex and difficult issues involved.

45. Introduction to Psychology, 7th Edition, James W. Kalat Chapter 16: Specific Disorders and Treatments Module 16.3 l Mood Disorders

46. Introduction to Psychology, 7th Edition, James W. Kalat Chapter 16: Specific Disorders and Treatments Mood Disorders l Depression n Major depression m Major depression is an extreme condition. m It usually persists for months. m The person experiences little interest in anything, little pleasure, and little motivation to be productive.

47. Introduction to Psychology, 7th Edition, James W. Kalat Chapter 16: Specific Disorders and Treatments Mood Disorders l Depression n Major depression m Loss of interest in food and sex are common. m The person has feelings of worthlessness, guilt and powerlessness over their lives. m Sleep abnormalities are associated with depression (there is a characteristic rapid onset of REM sleep). m The person may attempt suicide.

48. Introduction to Psychology, 7th Edition, James W. Kalat Chapter 16: Specific Disorders and Treatments Figure 16.9 When most people go to sleep at their usual time, they progress slowly to stage 4 and then back through stages 3 and 2, reaching REM sleep toward the end of their first 90-minute cycle. Depressed people, however, reach REM more rapidly, generally in less than 45 minutes. They also tend to awaken frequently during the night.

49. Introduction to Psychology, 7th Edition, James W. Kalat Chapter 16: Specific Disorders and Treatments Mood Disorders l Depression n Seasonal affective disorder (SAD) m Consistent depression associated with a particular season of winter is called seasonal affective disorder. m It is most common in areas that have little sunlight in the winter. m It can be relieved by light therapy, which requires the depressed person to sit in front of a bright light for a few hours each day.

50. Introduction to Psychology, 7th Edition, James W. Kalat Chapter 16: Specific Disorders and Treatments Figure 16.10 Most people feel slightly better during the summer (when the sun is out most of the day) than during the winter (when there are fewer hours of sunlight). People with seasonal affective disorder (SAD) feel good in the summer and seriously depressed in the winter (or good in the winter and depressed in the summer). Seasonal affective disorder is commonest in far northern locations such as Scandinavia, where the summer days are very long and bright and the winter days are very short and dark. The disorder is unheard-of in tropical locations such as Hawaii, where the amount of sunlight per day varies only slightly between summer and winter.

51. Introduction to Psychology, 7th Edition, James W. Kalat Chapter 16: Specific Disorders and Treatments Mood Disorders l Depression n Bipolar disorder m This condition was once referred to as manic- depressive disorder. m It involves a cycling of mood between periods of depression and periods of mania. m Mania is a state of extreme exuberance and agitation.

52. Introduction to Psychology, 7th Edition, James W. Kalat Chapter 16: Specific Disorders and Treatments Mood Disorders l Depression n Genetic predisposition to depression m Having close biological relatives who were diagnosed with depression increases one’s probability of becoming depressed. m Having adoptive relatives who were depressed also increases that probability, but not as much.

53. Introduction to Psychology, 7th Edition, James W. Kalat Chapter 16: Specific Disorders and Treatments Mood Disorders l Depression n Genetic predisposition to depression m The probability is especially high if one has biological relatives who were diagnosed with depression before age 30. m There is probably no one gene that causes depression. m Genes probably influence temperament and therefore also the way people respond to events in their lives.

54. Introduction to Psychology, 7th Edition, James W. Kalat Chapter 16: Specific Disorders and Treatments Mood Disorders l Depression n Sex differences in depression m Before adolescence, depression is about equally common in boys and girls. m From adolescence onward, women are about twice as likely to experience depression as men.

55. Introduction to Psychology, 7th Edition, James W. Kalat Chapter 16: Specific Disorders and Treatments Mood Disorders l Depression n Sex differences in depression: hormones m Women experience more rapid hormonal changes than men do (menstrual cycles, pregnancy, childbirth and menopause). m Postpartum depression is triggered by the rapid hormonal changes that follow childbirth. m However, the hormone levels of depressed women are not significantly different that those of non- depressed women.

56. Introduction to Psychology, 7th Edition, James W. Kalat Chapter 16: Specific Disorders and Treatments Mood Disorders l Depression n Sex differences in depression: coping m Men generally try to distract themselves when they are feeling depressed. Women tend to dwell on their feelings more. m Ruminating may not be useful for coping and may make the person feel worse. m This explanation does not account for why women and men choose different strategies.

57. Introduction to Psychology, 7th Edition, James W. Kalat Chapter 16: Specific Disorders and Treatments Mood Disorders l Depression n Events that precipitate depression m People generally become depressed after losses or other negative events occur. m There is little relationship between the scale of the event and the intensity and duration of the subsequent depression. m Severe losses early in life may make people more vulnerable to depression later on in life.

58. Introduction to Psychology, 7th Edition, James W. Kalat Chapter 16: Specific Disorders and Treatments Mood Disorders l Depression n Events that precipitate depression m Lack of social support also increases vulnerability to depression. m As in the case of stress, it is not just the event but also the person’s interpretation of the event’s significance that influences the degree of depression. m The way people think about their lives, as well as the course of the events, is a factor to consider.

59. Introduction to Psychology, 7th Edition, James W. Kalat Chapter 16: Specific Disorders and Treatments Mood Disorders l Depression n Cognitive aspects of depression m Every person has an explanatory style in accounting for successes and failures. m Internal attributions cite causes within the person. m External attributions identify causes outside the person.

60. Introduction to Psychology, 7th Edition, James W. Kalat Chapter 16: Specific Disorders and Treatments Mood Disorders l Depression n Cognitive aspects of depression m People tend to be more consistent in the type of attributions that they use to explain their failures. m People who blame themselves for all failures, regardless of the circumstances, develop a pessimistic explanatory style. m They view their failures as global (consistent over situations) and stable (consistent over time). “Depressed people believe that every silver lining has a cloud.” -- Kalat

61. Introduction to Psychology, 7th Edition, James W. Kalat Chapter 16: Specific Disorders and Treatments Mood Disorders l Depression n Treatments for depression m Cognitive therapy helps the individual develop more positive beliefs. m Drug therapies use anti-depressant medications including the tricyclics, selective serotonin reuptake inhibitors, monoamine oxidase inhibitors, and atypical antidepressants. m St. John’s Wort is a naturally occurring herb that has antidepressant effects. It should not be used with other medications.

62. Introduction to Psychology, 7th Edition, James W. Kalat Chapter 16: Specific Disorders and Treatments Figure 16.13 Antidepressant drugs prolong the activity of the neurotransmitters dopamine, norepinephrine, and serotonin. (a) Ordinarily, after the release of one of the neurotransmitters, some of the molecules are reabsorbed by the terminal button, and other molecules are broken down by the enzyme monoamine oxidase (MAO). (b) Selective serotonin reuptake inhibitors (SSRIs) prevent reabsorption of serotonin. Tricyclic drugs prevent reabsorption of dopamine, norepinephrine, and serotonin. (c) MAO inhibitors (MAOIs) block the enzyme monoamine oxidase and thereby prolong the effects of the neurotransmitters.

63. Introduction to Psychology, 7th Edition, James W. Kalat Chapter 16: Specific Disorders and Treatments Mood Disorders l Depression n Treatments for depression m Electroconvulsive shock therapy (ECT) is a well- known but controversial treatment. m A brief electrical shock is administered to the patient’s head. m It induces a convulsion similar to an epileptic seizure. m How it works is not fully understood.

64. Introduction to Psychology, 7th Edition, James W. Kalat Chapter 16: Specific Disorders and Treatments Mood Disorders l Depression n Treatments for depression m It is an effective treatment, although the benefits are temporary. Other treatments must be offered also. m ECT fell out of favor because it was widely abused (administered without patient consent, given too often, used as a threat). m It is now used only for patients who have treatment- resistant depressions or who are strongly suicidal.

65. Introduction to Psychology, 7th Edition, James W. Kalat Chapter 16: Specific Disorders and Treatments Mood Disorders l Bipolar disorder n Bipolar disorder: symptoms m People whose moods alternate between extremes of mania and depression are said to suffer from bipolar disorder. m When they are experiencing mania, they are constantly active and uninhibited, and may be very happy or very irritable.

66. Introduction to Psychology, 7th Edition, James W. Kalat Chapter 16: Specific Disorders and Treatments Mood Disorders l Bipolar Disorder n Bipolar Disorder: types m Psychologists diagnose two types of bipolar disorder. m Bipolar I disorder involves the experience of at least one episode of mania. m Bipolar II disorder involves alternation between major depression and hypomania, which is a milder form of mania.

67. Introduction to Psychology, 7th Edition, James W. Kalat Chapter 16: Specific Disorders and Treatments Mood Disorders l Bipolar disorder n Bipolar disorder: prevalence m About 1% of the adult population of the U.S. has been diagnosed with a Bipolar Disorder. m It can be difficult to distinguish bipolar from other disorders (attention deficits, delusions and hallucinations are also symptoms of other disorders). m There are hereditary influences on bipolar disorder.

68. Introduction to Psychology, 7th Edition, James W. Kalat Chapter 16: Specific Disorders and Treatments Mood Disorders l Bipolar disorder n Drug therapies for bipolar disorder m Lithium is a naturally occurring chemical that is used to treat mania. m How lithium relieves mania is not well understood. m Lithium is toxic at high doses, so a patient who takes it must be carefully monitored. m Valproate and anticonvulsant drugs are also used to treat bipolar disorders.

69. Introduction to Psychology, 7th Edition, James W. Kalat Chapter 16: Specific Disorders and Treatments Mood Disorders l Suicide n Mood disorders and suicide m People who suffer from depression and bipolar disorders consider suicide. Some make attempts. m It is hard to know the true rate of suicide because some suicides are disguised to look like accidents. m Suicide rates vary as a function of gender, culture and age

70. Introduction to Psychology, 7th Edition, James W. Kalat Chapter 16: Specific Disorders and Treatments Figure 16.15 Suicide rates differ as a function of age, gender, and culture. The rates shown here are for 1988; the rate has dropped since then for Hungary, presumably because of economic and social changes within the country. (Based on data of Lester, 1996)

71. Introduction to Psychology, 7th Edition, James W. Kalat Chapter 16: Specific Disorders and Treatments Figure 16.15 Suicide rates differ as a function of age, gender, and culture. The rates shown here are for 1988; the rate has dropped since then for Hungary, presumably because of economic and social changes within the country. (Based on data of Lester, 1996)

72. Introduction to Psychology, 7th Edition, James W. Kalat Chapter 16: Specific Disorders and Treatments Table 16.5 People most likely to attempt suicide

73. Introduction to Psychology, 7th Edition, James W. Kalat Chapter 16: Specific Disorders and Treatments Mood Disorders l Suicide n Mood disorders and suicide m Women make more attempts but tend to employ less lethal means than do men. m There is no dependable pattern to suicide, but certain warning signs and risk factors are associated with it. m Previous attempts, a history of losses, a recent loss, and a family history are all likely to raise the risk.

74. Introduction to Psychology, 7th Edition, James W. Kalat Chapter 16: Specific Disorders and Treatments Mood Disorders l Suicide n Mood disorders and suicide m If someone you know is thinking of suicide, try to treat the person as you would any other person who is in distress. m Offer support and friendship, and don’t be afraid to ask him or her to talk about feelings. m Encourage the person to seek professional help if you sense that they are open to the suggestion.

75. Introduction to Psychology, 7th Edition, James W. Kalat Chapter 16: Specific Disorders and Treatments Mood and Mood Disorders l Our capacity to experience emotions is an important part of our lives. We have a wide range of pleasant and unpleasant feelings to color our days. l Mood disorders go beyond this typical spectrum, and victimize the person, distorting their perspective. Our ways to manage these disorders have improved over the past decades, providing many with relief from this distortion.

76. Introduction to Psychology, 7th Edition, James W. Kalat Chapter 16: Specific Disorders and Treatments Module 16.4 l Schizophrenia

77. Introduction to Psychology, 7th Edition, James W. Kalat Chapter 16: Specific Disorders and Treatments Schizophrenia l What is schizophrenia? n Many people confuse the term schizophrenia with dissociative identity disorder or multiple personality disorder. n The split in schizophrenia refers to a disconnection of the intellectual and emotional aspects of the personality.

78. Introduction to Psychology, 7th Edition, James W. Kalat Chapter 16: Specific Disorders and Treatments Figure 16.16 Although the term schizophrenia is derived from Greek roots meaning “split personality,” it does not refer to cases where people alternate among different personalities. Rather, the term originally indicated a split between the intellectual and emotional aspects of a single personality.

79. Introduction to Psychology, 7th Edition, James W. Kalat Chapter 16: Specific Disorders and Treatments Schizophrenia l What is schizophrenia? n The DSM-IV diagnosis of schizophrenia requires that the person exhibit a complete deterioration of daily activities along with at least two of the following symptoms: m Hallucinations m Delusions or thought disorders m Incoherent speech m Grossly disorganized behavior m Loss of normal emotional responses and social behaviors

80. Introduction to Psychology, 7th Edition, James W. Kalat Chapter 16: Specific Disorders and Treatments Schizophrenia l Symptoms of schizophrenia n It is possible for two people with schizophrenia to have very different symptom patterns m The symptoms are divided into two broad types. m Positive symptoms are behaviors that are notable because of their presence (hallucinations and delusions, for example). m Negative symptoms are behaviors that are notable because of their absence (lack of emotional expression).

81. Introduction to Psychology, 7th Edition, James W. Kalat Chapter 16: Specific Disorders and Treatments Schizophrenia l Symptoms of schizophrenia n Positive symptoms m Hallucinations are false sensory experiences. m Hearing voices is a common auditory hallucination of schizophrenia. m Visual hallucinations occur but are less common.

82. Introduction to Psychology, 7th Edition, James W. Kalat Chapter 16: Specific Disorders and Treatments Schizophrenia l Symptoms of schizophrenia n Positive symptoms m Delusions are unfounded beliefs. m There are three types of delusions associated with schizophrenia – persecution, grandeur, and ideas of reference. m As it is sometimes hard to distinguish between the unusual opinion and a delusion, one cannot diagnose a psychotic disorder on the basis of such ideas alone.

83. Introduction to Psychology, 7th Edition, James W. Kalat Chapter 16: Specific Disorders and Treatments Schizophrenia l Symptoms of schizophrenia n Positive symptoms m Disordered thinking refers to a deficit in utilizing “executive functions.” m Deficits of attention, difficulty in switching rules and routines, loose associations, and difficulties with abstraction are all common types of disordered thinking in people suffering from schizophrenia.

84. Introduction to Psychology, 7th Edition, James W. Kalat Chapter 16: Specific Disorders and Treatments Schizophrenia l Types and prevalence n Four types of schizophrenia m Undifferentiated m Catatonic m Disorganized m Paranoid

85. Introduction to Psychology, 7th Edition, James W. Kalat Chapter 16: Specific Disorders and Treatments Schizophrenia l Four types of schizophrenia n The symptoms of undifferentiated schizophrenia include: m Deterioration of daily functioning m Hallucinations m Delusions or thought disorders m Inappropriate emotions n None of the symptoms is unusually pronounced or bizarre.

86. Introduction to Psychology, 7th Edition, James W. Kalat Chapter 16: Specific Disorders and Treatments Schizophrenia l Four types of schizophrenia n Catatonic schizophrenia is distinguished by prominent movement disorder, including either: m Rigid inactivity m Excessive activity m The person is aware of his or her surroundings, but the nature of the individual’s posture or movement has no relationship to the outside world.

87. Introduction to Psychology, 7th Edition, James W. Kalat Chapter 16: Specific Disorders and Treatments Schizophrenia l Four types of schizophrenia n The symptoms of disorganized schizophrenia include: m Incoherent speech m Extreme lack of social relationships m “Silly” or odd behavior

88. Introduction to Psychology, 7th Edition, James W. Kalat Chapter 16: Specific Disorders and Treatments Schizophrenia l Four types of schizophrenia n The symptoms of paranoid schizophrenia include: m Elaborate hallucinations and delusions m The delusions have pronounced themes of persecution and grandeur. m Other thought problems tend to be less pronounced, and some people with paranoid schizophrenia are relatively intact cognitively.

89. Introduction to Psychology, 7th Edition, James W. Kalat Chapter 16: Specific Disorders and Treatments Schizophrenia l Prevalence n Prevalence of schizophrenia m About 1% of Americans are afflicted with schizophrenia at some time in the lifespan. m In general, the rates of this disorder have been declining over the past 100 years. m It occurs in many cultures, but is less common in developing nations.

90. Introduction to Psychology, 7th Edition, James W. Kalat Chapter 16: Specific Disorders and Treatments Schizophrenia l Prevalence n Prevalence of schizophrenia m Schizophrenia is most frequently diagnosed in young adults. m Men are usually diagnosed earlier than women. m The onset is typically sudden, although there are some markers during childhood.

91. Introduction to Psychology, 7th Edition, James W. Kalat Chapter 16: Specific Disorders and Treatments Schizophrenia l Causes n Genetic influences m Studies of twins and adopted children suggest a genetic basis for the disease. m In identical twins, if one member of the pair develops schizophrenia, there is a 50% chance that the other will also. m As with most other genetic research, it is difficult to control for the effects of the prenatal environment.

92. Introduction to Psychology, 7th Edition, James W. Kalat Chapter 16: Specific Disorders and Treatments Figure 16.18 The relatives of a schizophrenic person have an increased probability of developing schizophrenia themselves. Note that children of a schizophrenic mother have a 17% risk of schizophrenia even if adopted by a family with no schizophrenic members. (Based on data from Gottesman, 1991)

93. Introduction to Psychology, 7th Edition, James W. Kalat Chapter 16: Specific Disorders and Treatments Schizophrenia l Causes n Genetic influences m So far researchers have not located a specific gene for schizophrenia. m It is probably not a single-gene disorder. m It appears that certain people develop it without a genetic basis.

94. Introduction to Psychology, 7th Edition, James W. Kalat Chapter 16: Specific Disorders and Treatments Schizophrenia l Causes n Brain damage may have some influence on the development of schizophrenia. Brain scans indicate that: m The hippocampus and parts of the cerebral cortex are a little smaller than normal. m The cerebral ventricles are larger than normal. m People with schizophrenia have smaller neurons and fewer synapses in the prefrontal cortex.

95. Introduction to Psychology, 7th Edition, James W. Kalat Chapter 16: Specific Disorders and Treatments Schizophrenia l Causes n The neurodevelopmental hypothesis m The neurodevelopmental hypothesis states that schizophrenia is the result of nervous system impairments that develop before or at birth. m These impairments may be due to genetic or other reasons. m Non-genetic risk factors include: poor prenatal care, difficult pregnancy and labor, and mother’s exposure to influenza virus.

96. Introduction to Psychology, 7th Edition, James W. Kalat Chapter 16: Specific Disorders and Treatments Schizophrenia l Therapies for schizophrenia n Drug therapies m Antipsychotic or neuroleptic drugs help to relieve the symptoms of schizophrenia. m These drugs work gradually and vary in effectiveness from patient to patient.

97. Introduction to Psychology, 7th Edition, James W. Kalat Chapter 16: Specific Disorders and Treatments Schizophrenia l Therapies for schizophrenia n Drug therapies m Antipsychotic drugs work to block the production of dopamine at the synapses, which is evidence for the dopamine hypothesis of schizophrenia. m An alternative explanation is the glutamate hypothesis of schizophrenia, which is supported by the deficient stimulation of glutamate (a neurotransmitter that is inhibited by dopamine).

98. Introduction to Psychology, 7th Edition, James W. Kalat Chapter 16: Specific Disorders and Treatments Schizophrenia l Therapies for schizophrenia n Drug therapies m Tremors and involuntary movements begin gradually in people taking antipsychotics for many years, a condition known as tardive dyskinesia. m Atypical antipsychotic medications have been developed to provide relief without this troublesome side effect. m The atypical antipsychotics tend to suppress immune functioning in many patients, however.

99. Introduction to Psychology, 7th Edition, James W. Kalat Chapter 16: Specific Disorders and Treatments Schizophrenia l Therapies for schizophrenia n Family therapy for schizophrenia m Because caring for a schizophrenic family member can be stressful, family therapy can be useful in a number of ways. m It provides direct support for the healthy family members. m It reduces the additional risk to the patient by circumventing negative reactions to him or her by family members that might promote relapse.

100. Introduction to Psychology, 7th Edition, James W. Kalat Chapter 16: Specific Disorders and Treatments Figure 16.20 This graph indicates that during 2 1/2 years following apparent recovery from schizophrenia, the percentage of schizophrenic patients who remained improved is higher in the group that received continuing drug treatment than in the placebo group. But the graph also shows that antipsychotic drugs do not always prevent relapse. (Based on Baldessarini, 1984)

101. Introduction to Psychology, 7th Edition, James W. Kalat Chapter 16: Specific Disorders and Treatments The Elusiveness of Schizophrenia l Two people with schizophrenia may present their illness in very different ways. The causes of their illnesses may turn out to be very different. l Psychologists are still uncertain whether we are looking at one disorder or several. We still have so much to learn about this complex illness.