2Key Questions What are the general characteristics of psychosis? How do delusional disorders differ from other forms of psychosis?What forms does schizophrenia take?What causes schizophrenia?What are mood disorders? What causes depression?How are major mental disorders treated?Who do people commit suicide? Can suicide be prevented?What does it mean to be “crazy”? What should be done about it?
4Psychosis and Hallucinations Loss of contact with shared views of realityHallucinations:Imaginary sensations, such as seeing, hearing, or smelling things that do not exist in the real worldMost common psychotic hallucination is hearing voicesNote that olfactory hallucinations sometimes occur with seizure disorder (epilepsy)
5Psychosis and Hallucinations Delusions:False beliefs that individuals insist are true, regardless of overwhelming evidence against themDepressiveSomaticGrandeurInfluencePersecutionReference
6Some More Psychotic Symptoms Flat Affect:Lack of emotional responsiveness; face is frozen in blank expressionDisturbed Verbal Communication:Garbled and chaotic speech; word saladPersonality Disintegration:When an individual’s thoughts, actions, and emotions are uncoordinatedBrief Reactive Psychosis:Psychotic symptoms typically appear after an extremely stressful event
7Table 18-1 Common Warning Signs of Psychosis and Major Mood Disorders Expresses bizarre thoughts or beliefs that defy realityHas withdrawn from family members and other relationshipsHears unreal voices, sees things others don’tIs extremely sad, persistently despondent, or suicidalIs excessively energetic, has little need for sleepLoses appetite, sleeps excessively, has no energyExhibits extreme mood swingsBelieves someone is trying to harm her or himHas engaged in anti-social, destructive, or self-destructive behavior
8Other Psychotic Disorders Organic Psychosis:Psychosis caused by brain injury (gunshot wound) or diseaseFunctional psychosisBased on unknown causes or psychological factors
9Organic Psychosis Dementia: Alzheimer’s Disease: Most common organic psychosis; serious mental impairment in old age caused by brain deteriorationArchaically known as senility (senile dementia)Alzheimer’s Disease:Symptoms include impaired memory, confusion, and progressive loss of mental abilitiesRonald Reagan most famous Alzheimer’s victim(Page 587)
10Organic Psychosis Cinema Education The Notebook A Moment to Remember (Subtitled)
11Delusional Disorders Delusional Disorders: Paranoid Psychosis: Marked by presence of deeply held false beliefs (delusions)May involve delusions of grandeur, persecution, jealousy, or somatic delusionsExperiences could really occur!Paranoid Psychosis:Most common delusional disorderCenters on delusions of persecution
12Schizophrenia: The Most Severe Mental Illness Psychotic disorder characterized by hallucinations, delusions, apathy, thinking abnormalities, and “split” between thoughts and emotionsDoes NOT refer to having split or multiple personalities
13The Four Subtypes of Schizophrenia Disorganized (Hebephrenic) Type: Incoherence, grossly disorganized behavior, bizarre thinking, and flat or inappropriate emotionsCatatonic Type: Marked by stupor, unresponsiveness, posturing, and mutismParanoid Type: Preoccupation with delusions; also involves auditory hallucinations that are related to a single theme, especially grandeur or persecutionUndifferentiated Type: Any type of schizophrenia that does not have specific paranoid, catatonic, or disorganized features or symptoms
15Causes of Schizophrenia EnvironmentPsychological Trauma:Psychological injury or shock, often caused by violence, abuse, or neglectDisturbed Family Environment:Stressful or unhealthy family relationships, communication patterns, and emotional atmosphereDeviant Communication Patterns:Cause guilt, anxiety, anger, confusion, and turmoilDouble-bind communication:Places the listener in an unsolvable emotional conflict, or “no-win” situation
16Causes of Schizophrenia HereditySome individual inherit a potential for developing schizophreniaThey are more vulnerable to the disorder than others areEX: If 1 identical twin becomes schizophrenic (identical twins have identical genes) then the other twin has a 48% chance of also becoming schizophrenic
17Research ClassicThe Genain Sisters- Trouble times four (page 592)
18Fig Lifetime risk of developing schizophrenia is associated with how closely a person is genetically related to a schizophrenic person. A shared environment also increases the risk. (Estimates from Lenzenweger & Gottesman, 1994.)
19Biochemical Causes of Schizophrenia Biochemical Abnormality:Disturbance in brain’s chemical systems or in the brain’s neurotransmittersDopamine:Neurotransmitter involved with emotions and muscle movementWorks in limbic systemDopamine overactivity in brain may be related to schizophrenia
20Fig Dopamine normally crosses the synapse between two neurons, activating the second cell. Antipsychotic drugs bind to the same receptor sites as dopamine does, blocking its action. In people suffering from schizophrenia, a reduction in dopamine activity can quiet a person’s agitation and psychotic symptoms.
21Louis WainThis series of paintings by Louis Wain reflects a troubled personality. Wain was a British illustrator who became schizophrenic in middle age. As Wain’s psychosis progressed, his cat paintings became highly abstract and fragmented. In many ways, Wain’s paintings resemble the perceptual changes caused by psychdelic drugs such as LSD. Recent research suggests that psychosis may, in fact, be the result of mind-altering changes in brain chemistry
22Schizophrenic Brain Computed Tomography (CT) Scan: Computer enhanced X-ray of brain or bodyMagnetic Resonance Imaging (MRI) Scan:Computer enhanced three-dimensional image of brain or body; based on magnetic fieldMRIs show schizophrenic brains as having enlarged ventriclesPositron Emission Tomography (PET) Scan:Computer-generated color image of brain activity; radioactive sugar solution is injected into a vein, eventually reaching the brainActivity is abnormally low in frontal lobes of schizophrenics
24Fig Positron emission tomography produces PET scans of the human brain. In the scans shown here, red, pink, and orange indicate lower levels of brain activity; white and blue indicate higher activity levels. Notice that activity in the schizophrenic brain is quite low in the frontal lobes (top area of each scan) (Velakoulis & Pantelis, 1996). Activity in the manic-depressive brain is low in the left brain hemisphere and high in the right brain hemisphere. The reverse is more often true of the schizophrenic brain. Researchers are trying to identify consistent patterns like these to aid diagnosis of mental disorders.
26Stress-Vulnerability Model Stress-Vulnerability Hypothesis:Combination of environmental stress and inherited susceptibility cause schizophrenic disorders
27Fig Various combinations of vulnerability and stress may produce psychological problems. The top bar shows low vulnerability and low stress. The result? No problem. The same is true of the next bar down, where low vulnerability is combined with moderate stress. Even high vulnerability (third bar) may not lead to problems if stress levels remain low. However, when high vulnerability combines with moderate or high stress (bottom two bars) the person “crosses the line” and suffers from psychopathology.
28Mood Disorders Mood disorders: Depressive Disorders: Major disturbances in emotion, such as depression or maniaDepressive Disorders:Sadness or despondency are prolonged, exaggerated, or unreasonableBipolar Disorders:Involve both depression and mania or hypomaniaDysthymic Disorder:Moderate depression that lasts for at least two yearsCyclothymic Disorder:Moderate manic and depressive behavior that lasts for at least two yearsReactive depression:Is an episode of despondency that follows some identifiable event
29Major Mood Disorders Major mood disorders: Major Depressive Disorder: Lasting extremes of mood or emotion and sometimes with psychotic features (hallucinations, delusions)Major Depressive Disorder:A mood disorder where the person has suffered one or more intense episodes of depression; one of the more serious mood disordersBipolar I Disorder:Extreme mania and deep depression; one type of manic-depressive illnessMania: Excited, hyperactive, energetic, grandiose behaviorBipolar II Disorder:Person is mainly sad but has one or more hypomanic episodes (mild mania)Affective psychosis:Combination of mood disorder and a break with reality
30Major Mood Disorders (cont.) Endogenous Depression:Depression that seems to be produced from inside the body (due to chemical imbalances) and NOT from life eventsSeasonal Affective Disorder (SAD):Depression that only occurs during fall and winterMay be related to reduced exposure to sunlightPhototherapy: Extended exposure to bright light to treat SAD
31Comic Book characters and their problems Batman and his FoesComic Book characters and their problems
33Fig Seasonal affective disorder appears to be related to reduced exposure to daylight during the winter. SAD affects 1 to 2 percent of Florida’s population, about 6 percent of the people living in Maryland and New York City, and nearly 10 percent of the residents of New Hampshire and Alaska (Booker & Hellekson, 1992).
35Maternity Blues Maternity Blues: Mild depression that lasts for one to two days after childbirthMarked by crying, fitful sleep, tension, anger, and irritabilityBrief and not too severe
36Postpartum Depression Moderately severe depression that begins within three months following childbirthMarked by mood swings, despondency, feelings of inadequacy, and an inability to cope with the new babyMay last from two months to one yearPart of the problem may be hormonal
37Fig At least one schizophrenic patient in four had completely recovered 10 years after being diagnosed. Three out of four had improved. New treatments for schizophrenia and other major mental disorders may improve these odds. (Source: FDA Consumer, 1993.)
38Therapeutic Interventions Psychotherapy:Any psychological treatment for behavioral or emotional problemsTypically involves two people talking about one’s personal problemsSomatic Therapies:BodilyDrug therapy, hospitalization, or psychosurgeryPharmacotherapy:Use of drugs to alleviate the symptoms of emotional disturbance
39Pharmacotherapy What type of drugs are used in pharmacotherapy? TranquilizersDrugs (Valium) that produce relaxation or reduce anxietyAntidepressantsAre mood elevating drugs used to combat depressionAntipsychoticsDrugs that, in addition to having tranquilizing effects, also tend to reduce hallucinations and delusional thinking.
41Shock Electroconvulsive Therapy (ECT) How does shock help? A 150-volt electrical current is passed through the brain for slightly less than a secondHow does shock help?It is the seizure that helps, which is induced by the shock
42Psychotherapy Psychotherapy Any surgical alteration of the brain Best known psychotherapyPrefrontal lobotomy: The frontal lobes are surgically disconnected from the other areas of the brainDeep lesioning: Small target areas are destroyed in the brain’s interior
43Suicide: Major Risk Factors Drug or alcohol abusePrior suicide attemptDepression or other mood disorderAvailability of a firearmSevere anxiety or panic attacksFamily history of suicidal behaviorShame, humiliation, failure or rejection
44Fig Adolescent suicide rates vary for different racial and ethnic groups. Higher rates occur among whites than among non-whites. White male adolescents run the highest risk of suicide. Considering gender alone, it is apparent that more male than female adolescents commit suicide. This is the same as the pattern observed for adults.
45Common Characteristics of Suicidal Thoughts and Feelings (Page 605) EscapeUnbearable Psychological Pain: Emotional pain that the person wishes to escapeFrustrated Psychological Needs: Such as searching for love, achievement, or securityConstriction of Options: Feeling helpless and hopeless and deciding that death is the only option left
46Fig Suicidal behavior usually progresses from suicidal thoughts, to threats, to attempts. A person is unlikely to make an attempt without first making threats. Thus, suicide threats should be taken seriously (Garland & Zigler, 1993).