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Psychological Disorders

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1 Psychological Disorders
PSYCHOLOGY Mr. Noble A special thanks to my former student teacher--Ms. Sharon Mohr--for her diligent research, insightful professional expertise, and valuable thoughtful effort in compiling much of the information included in this overview of Psychological Disorders.

2 Defining Abnormality Difficult to define… 3 Criteria…
Deviance Distress Disability/Maladaptive Behavior Symptom/Behavior Continuum: _----_________________ normal range__ __________________+++ Abnormal Abnormal

3 Ancient Perspective Perceived Causes Ancient Treatments
movements of sun or moon lunacy- full moon evil spirits Ancient Treatments exorcism, caged like animals, beaten, burned, mutilated, blood replaced with animal’s blood

4 Bio-psycho-social Model
assumes that biological, sociocultural, and psychological factors combine and interact to produce psychological disorders Biological (chemistry, brain) Psychological ( learned helplessness, negative perceptions and memories) Sociocultural (Societal expectations, definition of normality and disorder)

5 Medical Model Diagnosis Prognosis Etiology Label for a set of symptoms
Prediction or forecast for the course of a D/O Etiology Suspected cause of a disorder

6 Classifying Disorders
DSM-IV-TR Diagnostic and Statistical Manual of Mental Disorders, 4th edition, Text Revision Published by the American Psychiatric Association 2000…(most recent update 2004) Next major revision (DSM-V) anticipated for 2011. Provides for reliable classification and description of all mental illnesses Allows for better communication

7 DSM’s Multi-axial Diagnosis
Axis I Major Clinical Disorders Axis II Mental Retardation & Personality Disorders Axis III General Medical Conditions Axis IV Psychosocial/Environmental Stressors Axis V Global Assessment of Functioning # between 1 and 100 Current and Highest in past year

8 Labeling Issues Reasons to Label/Diagnose: Arguments against Labeling:
Needed for communication Guide treatment Insurance reimbursement Arguments against Labeling: Creates a stigma Creates a self-fulfilling prophecy Fail to see the person behind the disorder

9 Major Classes of Disorders
Anxiety Disorders Mood Disorders Somatoform Disorders Dissociative Disorders Schizophrenia Substance Use Disorders Other Axis I Disorders Personality Disorders (Axis II)

10 I. Anxiety Disorders Characterized by generalized apprehension, worry, and a variety of physical symptoms Generalized Anxiety Disorder Phobias Panic Disorder Obsessive-Compulsive Disorder Post-traumatic Stress Disorder

11 Generalized Anxiety Disorder
Experiencing a continuous, generalized feeling of anxiety (reaction to vague or imagined dangers) – 6 months or more Anxiety in many different areas of life Accompanied by physical symptoms… muscle tension, trouble sleeping, irritability, lack of concentration, headaches, fatigue, inability to relax, twitching/trembling, etc.

12 Phobias Specific Phobia Social Phobia Agoraphobia
Severe anxiety is focused on a specific object or situation Examples: Enclosed spaces Snakes Spiders Heights Flying Social Phobia Fear of embarrassing oneself in a social situation Speaking, eating, using bathroom in public Agoraphobia “fear of the marketplace” Associated with panic disorder

Common and uncommon phobias Afraid of it Bothers slightly Not at all afraid of it Being closed in, in a small place alone In a house at night Percentage of people surveyed 100 90 80 70 60 50 40 30 20 10 Snakes in high, exposed places Mice Flying on an airplane Spiders and insects Thunder lightning Dogs Driving a car In a crowd Cats

14 PHOBIAS Treatment Exposure Treatment Flooding Counter-Conditioning
Systematic Desensitization (1) training the patient to physically relax (2) establishing an anxiety hierarchy of the stimuli (3) counter-conditioning relaxation responding to ea. feared stimulus Biofeedback Modeling

15 Panic Disorder Frequent Panic Attacks or fear of them:
“Nothing is so much to be feared as Fear” ---Henry David Thoreau Panic Disorder Frequent Panic Attacks or fear of them: Sudden and unexplainable attacks of intense fear Come on without warning Not associated with a stimulus Individual fears that he/she is about to die Physical symptoms…choking, tightness in chest, difficulty breathing, nausea, dizziness Commonly occurs with Agoraphobia

16 Obsessive-Compulsive Disorder
OBSESSIONS Intrusive and uncontrollable thoughts Contamination, safety, etc. COMPULSIONS Ritualistic and purposeless actions Cleaning, washing, checking, etc. O and C are usually related… compulsions help to decrease the anxiety caused by the obsession This pattern begins to interfere with functioning

17 OCD Common Obsessions and Compulsions Among
People With Obsessive-Compulsive Disorder Thought or Behavior Percentage* Reporting Symptom Obsessions (repetitive thoughts) Concern with dirt, germs, or toxins Something terrible happening (fire, death, illness) Symmetry order, or exactness Excessive hand washing, bathing, tooth brushing, or grooming Compulsions (repetitive behaviors) Repeating rituals (in/out of a door, up/down from a chair) Checking doors, locks, appliances, car brake, homework

18 Post-traumatic Stress Disorder
Common among veterans of combat, survivors of accidents and disasters, victims of crimes, etc. Feel long-lasting after-effects of trauma Flashbacks, nightmares, insomnia, mood symptoms, stimulus generalization Symptoms last more than 1 month… up to years later

19 II. Mood Disorders Mental disorders characterized by disturbances of mood that are intense and persistent enough to be maladaptive Normal range of mood… Major Depressive Disorder Bipolar Disorder

20 Major Depressive Disorder
Clinical depression/Major Depression Unipolar depression Single-episode or recurrent episodes Symptoms must occur for at least 2 weeks Subtypes: Post-partum onset S.A.D. Secondary symptoms…

21 Depression…symptoms Guilt/worthlessness Energy  = fatigue
Sleep disturbance Interest  Guilt/worthlessness Energy  = fatigue Concentration  Appetite disturbance/weight gain/loss Psychomotor agitation/retardation Suicidal/thoughts of death

22 Causes of Depression Genetic Predisposition Neurotransmitters
+ stressful life events Neurotransmitters Serotonin Norepinephrine Cognitive Theories Beck & Seligman Behavioral Theories


24 Bipolar Disorder Previously known as Manic-Depression
Experience both manic and depressive episodes Mania = emotional state characterized by intense and unrealistic feelings of excitement and euphoria, along with impulsivity Cycles…not mood swings High rate of suicide

25 Mood Disorders-Bipolar
PET scans show that brain energy consumption rises and falls with emotional swings Depressed state Manic state

26 Mood Disorders & Suicide
Not all people who commit suicide are depressed; Not all depressed people commit suicide Associated with mood disorders, especially bipolar disorder (also schizophrenia) Warning Signs… Risk factors… Prevention…

27 SUICIDE: Male v. Female Males Females
Suicide is the eighth leading cause of death for all U.S. men. Males are four times more likely to die from suicide than females. Suicide rates are highest among Whites and second highest among American Indian and Native Alaskan men. Of the 24,672 suicide deaths reported among men in 2001, 60% involved the use of a firearm. Females Women report attempting suicide during their lifetime about three times as often as men.

28 SUICIDE: Youth Overall rate of suicide among youth has declined slowly since ‘92. However, rates remain unacceptably high. Adolescents and young adults often experience stress, confusion, and depression from situations occurring in their families, schools, and communities. Such feelings can overwhelm young people and lead them to consider suicide as a “solution.” Few schools and communities have suicide prevention plans that include screening, referral & crisis intervention programs for youth.

29 SUICIDE: Youth Suicide is the third leading cause of death among young people ages 15 to 24. Of the total number of suicides among ages 15 to 24 in 2001, 86% were male and 14% were female. American Indian and Alaskan Natives have the highest rate of suicide in the 15 to 24 age group. In 2001, firearms were used in 54% of youth suicides.


31 Previous suicide attempt(s)
SUICIDE: Risk Factors The first step in preventing suicide is to identify and understand the risk factors. Previous suicide attempt(s) History of mental disorders, particularly depression History of alcohol and substance abuse Family history of suicide Family history of child maltreatment Feelings of hopelessness Impulsive or aggressive tendencies Barriers to accessing mental health treatment

32 Loss (relational, social, work or financial) Physical illness
SUICIDE: Risk Factors The first step in preventing suicide is to identify and understand the risk factors. Loss (relational, social, work or financial) Physical illness Easy access to lethal methods Unwillingness to seek help due to stigma Local epidemics of suicide Isolation - feeling cut off from other people

33 Effective clinical care
SUICIDE: Protective Factors Protective factors buffer people from the risks associated with suicide. A number of protective factors have been identified: Effective clinical care Easy access to clinical interventions & support Family and community support Medical & mental health care relationships Problem solving, conflict resolution skills Cultural & religious beliefs/support

34 III. Somatoform Disorders
Also know as Hysteria (Freud) Conditions involving physical complaints or disabilities that occur without physical pathology NOT psychosomatic disorders… Conversion Disorder Hypochondriasis

35 Conversion Disorder Conversion of emotional difficulties into the persistent loss of a physiological function Paralysis, loss of feeling, exceptional sensitivity, mutism, blindness, deafness Not faking a physical problem Cannot be explained physically

36 Hypochondriasis & Somatization Disorders
History of diverse physical complaints of all varieties (all body systems) Focus on numerous symptoms Many trips to doctor, many medications, no root cause found Hypochondriasis Preoccupation with fear that he/she has a serious disease Based on the misinterpretation of bodily symptoms Mountain out of a molehill No evidence of illness

37 IV. Dissociative Disorders
Dissociation…the human mind’s capacity to mediate complex mental activity in channels split off from or independent of conscious awareness A way of managing anxiety and stress… Psychogenic/Dissociative Amnesia & Fugue Dissociative Identity Disorder

Inability to recall certain personal information, which is still know at the unconscious level Loss in episodic memory, not procedural or semantic PSYCHOGENIC FUGUE Loss of memory accompanied by an actual flight from one’s present life situation to a new environment May take on a new identity

39 Dissociative Identity Disorder
Previously known as Multiple Personality Disorder Individual manifests at least two or more distinct systems of identity Host personality + Alter identities (15) Associated with childhood abuse Rare disorder; Popular in media Can be faked or influenced by therapist

40 V. Schizophrenia Characterized by confused and disordered thoughts and perceptions Most debilitating of the mental disorders; Deterioration of adaptive behavior Subtypes: Paranoid Disorganized Catatonic Undifferentiated

41 Schizophrenia…symptoms
Bizarre behaviors (catatonia, others) Affect (inappropriate, flat) Delusions Speech (disorganized, incoherent) Hallucinations Inability to care for self or function Negative symptoms

42 Positive vs. Negative Sx
POSITIVE SYMPTOMS Presence of something abnormal Examples: NEGATIVE SYMPTOMS Absence of something normal

False beliefs maintained in the face of contrary evidence Types: Grandeur Identity Persecution Reference HALLUCINATIONS Sensations in the absence of external stimuli Types: visual, auditory, tactile, olfactory, gustatory

44 Causes of Schizophrenia
Genetic Predisposition Twin study evidence Neurotransmitters Dopamine hypothesis Brain Structure & Function Family & Interactions Double-bind theory Schizophrenogenic mother

45 VI. Substance Use Disorders
Substance Abuse Substance Dependence Psychological dependence + Addiction Alcoholism = Alcohol Dependence Important terms… Tolerance Withdrawal

46 VII. Other Axis I Disorders
Eating Disorders Sleep Disorders Disorders of childhood and adolescence Autism, ADHD, Tourette’s, Conduct Disorder Sexual and Gender Identity Disorders Cognitive Disorders Impulse Control Disorders Adjustment Disorders

47 VIII. Personality Disorders
Diagnosed on Axis II Stem from the gradual development of inflexible and distorted personality and behavioral patterns that result in persistently maladaptive ways of relating to the world Ego-syntonic…not a problem for the person A problem for others Resistant to treatment (only behavioral) FOCUS Antisocial, Narcissistic, OCPD

48 Symptoms of Obsessive Compulsive Personality Disorder
OCPD symptoms tend to appear early in adulthood and are defined by inflexibility, close adherence to rules, anxiety when rules are transgressed, and unrealistic perfectionism. A person with obsessive compulsive personality disorder exhibits several of the following symptoms: abnormal preoccupation with lists, rules, and minor details excessive devotion to work, to the detriment of social and family activities miserliness or a lack of generosity perfectionism that interferes with task completion, as performance is never good enough refusal to throw anything away (pack-rat mentality) rigid and inflexible attitude towards morals or ethical code unwilling to let others perform tasks, fearing the loss of responsibility upset and off-balance when rules or routines disrupted.

49 Psychopathology & The Law
Competence to Stand Trial Can individual participate in own defense at time of trial? Involuntary Civil Commitment Should individual be hospitalized against their will due to imminent danger? Suicidal or homicidal Decided by doctor, then court; need evidence

50 More Legal Issues…State-level
Insanity Plea Should individual not be held accountable due to their mental state at the time of the crime? Could not determine right from wrong Determined by judge before actual trial Difficult to prove, but prevalent in media Sent for treatment, then released *Insanity is a LEGAL term…!

51 More Legal Issues…State-level
Guilty but Mentally Ill Alternative to insanity plea in some states Adopted by Pennsylvania… 1st trial determines guilt or innocence 2nd trial determines sanity or insanity Sent for treatment, then to prison to complete sentence…get treatment as well as punishment

52 TYPES OF PSYCHOTHERAPY — A number of types of psychotherapy are used to treat psychological disorders: Cognitive therapy identifies habitual ways in which patients distort information (e.g. automatic thoughts) and teaches patients to identify, evaluate, and respond to their dysfunctional thoughts and beliefs, using a variety of techniques to change thinking, mood, and behavior. Cognitive therapy is a structured, goal oriented, problem focused, and time limited intervention.

Behavioral therapy attempts to alter behavior by systematically changing the environment that produces the behavior. Behavioral changes are believed to lead to changes in thoughts and emotions. Exposure-based behavioral treatments utilize gradual, systematic, repeated exposure to the feared object or situation to allow patients with anxiety disorders to become desensitized to the feared stimulus.

Cognitive Behavioral therapy (CBT) combines principles of both behavioral and cognitive therapy, focusing simultaneously on the environment, behavior, and cognition. Cognitive behavioral therapy is also structured, goal directed, problem focused. Patients learn how their thoughts contribute to symptoms of their disorder and how to change these thoughts. Increased cognitive awareness is combined with specific behavioral techniques.

Problem Solving therapy, a short-term, cognitive behavioral intervention, teaches a systematic method for solving current and future problems. Patients acquire new skills for successfully resolving interpersonal difficulties. These skills include the following sequential steps: 1) Problem definition; 2) Goal setting; 3) Generating, choosing, and implementing solutions; and 4) Evaluating outcomes.

Interpersonal therapy addresses issues such as grief, role transitions, interpersonal role disputes, and interpersonal deficits as they relate to the patient's current symptoms. Family therapy attempts to correct distorted communications and relationships as a means of helping the entire family, including the identified patient. In patients with serious mental illness, such as schizophrenia, family therapy helps family members learn about the disorder, solve problems, and cope more constructively with the patient's illness.

Psychoeducation provides patients with information about their diagnosis, its treatment, how to recognize signs of relapse, relapse prevention, and strategies to cope with the reality of prolonged emotional or behavioral difficulties. The goal of psychoeducation is to reduce distress, confusion, and anxiety within the patient and/or the patient's family to facilitate treatment compliance and reduce the risk of relapse. Psychoeducation is often particularly helpful for patients and the families of patients with chronic, severe psychiatric disorders such as schizophrenia and bipolar disorder.

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