Presentation on theme: "Psychological Disorders"— Presentation transcript:
1Psychological Disorders PSYCHOLOGYMr. NobleA 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.
2Defining Abnormality Difficult to define… 3 Criteria… DevianceDistressDisability/Maladaptive BehaviorSymptom/Behavior Continuum:_----_________________ normal range__ __________________+++Abnormal Abnormal
3Ancient Perspective Perceived Causes Ancient Treatments movements of sun or moonlunacy- full moonevil spiritsAncient Treatmentsexorcism, caged like animals, beaten, burned, mutilated, blood replaced with animal’s blood
4Bio-psycho-social Model assumes that biological, sociocultural, and psychological factors combine and interact to produce psychological disordersBiological(chemistry, brain)Psychological( learned helplessness,negative perceptionsand memories)Sociocultural(Societal expectations,definition of normalityand disorder)
5Medical Model Diagnosis Prognosis Etiology Label for a set of symptoms Prediction or forecast for the course of a D/OEtiologySuspected cause of a disorder
6Classifying Disorders DSM-IV-TRDiagnostic and Statistical Manual of Mental Disorders, 4th edition, Text RevisionPublished by the American Psychiatric Association2000…(most recent update 2004)Next major revision (DSM-V) anticipated for 2011.Provides for reliable classification and description of all mental illnessesAllows for better communication
7DSM’s Multi-axial Diagnosis Axis I Major Clinical DisordersAxis II Mental Retardation & Personality DisordersAxis III General Medical ConditionsAxis IV Psychosocial/Environmental StressorsAxis V Global Assessment of Functioning# between 1 and 100Current and Highest in past year
8Labeling Issues Reasons to Label/Diagnose: Arguments against Labeling: Needed for communicationGuide treatmentInsurance reimbursementArguments against Labeling:Creates a stigmaCreates a self-fulfilling prophecyFail to see the person behind the disorder
9Major Classes of Disorders Anxiety DisordersMood DisordersSomatoform DisordersDissociative DisordersSchizophreniaSubstance Use DisordersOther Axis I DisordersPersonality Disorders (Axis II)
10I. Anxiety DisordersCharacterized by generalized apprehension, worry, and a variety of physical symptomsGeneralized Anxiety DisorderPhobiasPanic DisorderObsessive-Compulsive DisorderPost-traumatic Stress Disorder
11Generalized Anxiety Disorder Experiencing a continuous, generalized feeling of anxiety (reaction to vague or imagined dangers) – 6 months or moreAnxiety in many different areas of lifeAccompanied by physical symptoms…muscle tension, trouble sleeping, irritability, lack of concentration, headaches, fatigue, inability to relax, twitching/trembling, etc.
12Phobias Specific Phobia Social Phobia Agoraphobia Severe anxiety is focused on a specific object or situationExamples:Enclosed spacesSnakesSpidersHeightsFlyingSocial PhobiaFear of embarrassing oneself in a social situationSpeaking, eating, using bathroom in publicAgoraphobia“fear of the marketplace”Associated with panic disorder
13PHOBIAS http://www.phobialist.com/reverse.html Common and uncommon phobiasAfraid of itBothers slightlyNot at all afraid of itBeingclosed in,in asmallplacealoneIn a houseat nightPercentageof peoplesurveyed100908070605040302010Snakesin high,exposedplacesMiceFlyingon anairplaneSpidersandinsectsThunderlightningDogsDrivinga carIn acrowdCats
14PHOBIAS 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 stimulusBiofeedbackModeling
15Panic Disorder Frequent Panic Attacks or fear of them: “Nothing is so much to be feared as Fear”---Henry David ThoreauPanic DisorderFrequent Panic Attacks or fear of them:Sudden and unexplainable attacks ofintense fearCome on without warningNot associated with a stimulusIndividual fears that he/she is about to diePhysical symptoms…choking, tightness in chest, difficulty breathing, nausea, dizzinessCommonly occurs with Agoraphobia
16Obsessive-Compulsive Disorder OBSESSIONSIntrusive and uncontrollable thoughtsContamination, safety, etc.COMPULSIONSRitualistic and purposeless actionsCleaning, washing, checking, etc.O and C are usually related… compulsions help to decrease the anxiety caused by the obsessionThis pattern begins to interfere with functioning
17OCD Common Obsessions and Compulsions Among People With Obsessive-Compulsive DisorderThought or BehaviorPercentage*Reporting SymptomObsessions (repetitive thoughts)Concern with dirt, germs, or toxinsSomething terrible happening (fire, death, illness)Symmetry order, or exactnessExcessive hand washing, bathing, tooth brushing,or groomingCompulsions (repetitive behaviors)Repeating rituals (in/out of a door,up/down from a chair)Checking doors, locks, appliances,car brake, homework
18Post-traumatic Stress Disorder Common among veterans of combat, survivors of accidents and disasters, victims of crimes, etc.Feel long-lasting after-effects of traumaFlashbacks, nightmares, insomnia, mood symptoms, stimulus generalizationSymptoms last more than 1 month… up to years later
19II. Mood DisordersMental disorders characterized by disturbances of mood that are intense and persistent enough to be maladaptiveNormal range of mood…Major Depressive DisorderBipolar Disorder
20Major Depressive Disorder Clinical depression/Major DepressionUnipolar depressionSingle-episode or recurrent episodesSymptoms must occur for at least 2 weeksSubtypes:Post-partum onsetS.A.D.Secondary symptoms…
21Depression…symptoms Guilt/worthlessness Energy = fatigue Sleep disturbanceInterest Guilt/worthlessnessEnergy = fatigueConcentration Appetite disturbance/weight gain/lossPsychomotor agitation/retardationSuicidal/thoughts of death
22Causes of Depression Genetic Predisposition Neurotransmitters + stressful life eventsNeurotransmittersSerotoninNorepinephrineCognitive TheoriesBeck & SeligmanBehavioral Theories
24Bipolar Disorder Previously known as Manic-Depression Experience both manic and depressive episodesMania = emotional state characterized by intense and unrealistic feelings of excitement and euphoria, along with impulsivityCycles…not mood swingsHigh rate of suicide
25Mood Disorders-Bipolar PET scans show that brain energy consumption rises and falls with emotional swingsDepressed stateManic state
26Mood Disorders & Suicide Not all people who commit suicide are depressed; Not all depressed people commit suicideAssociated with mood disorders, especially bipolar disorder (also schizophrenia)Warning Signs…Risk factors…Prevention…
27SUICIDE: 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.FemalesWomen report attempting suicide during their lifetime about three times as often as men.
28SUICIDE: YouthOverall 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.
29SUICIDE: YouthSuicide 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.
31Previous suicide attempt(s) SUICIDE: Risk FactorsThe first step in preventing suicide is to identify and understand the risk factors.Previous suicide attempt(s)History of mental disorders, particularly depressionHistory of alcohol and substance abuseFamily history of suicideFamily history of child maltreatmentFeelings of hopelessnessImpulsive or aggressive tendenciesBarriers to accessing mental health treatment
32Loss (relational, social, work or financial) Physical illness SUICIDE: Risk FactorsThe first step in preventing suicide is to identify and understand the risk factors.Loss (relational, social, work or financial)Physical illnessEasy access to lethal methodsUnwillingness to seek help due to stigmaLocal epidemics of suicideIsolation - feeling cut off from other people
33Effective clinical care SUICIDE: Protective FactorsProtective factors buffer people from the risks associated with suicide. A number of protective factors have been identified:Effective clinical careEasy access to clinical interventions & supportFamily and community supportMedical & mental health care relationshipsProblem solving, conflict resolution skillsCultural & religious beliefs/support
34III. Somatoform Disorders Also know as Hysteria (Freud)Conditions involving physical complaints or disabilities that occur without physical pathologyNOT psychosomatic disorders…Conversion DisorderHypochondriasis
35Conversion DisorderConversion of emotional difficulties into the persistent loss of a physiological functionParalysis, loss of feeling, exceptional sensitivity, mutism, blindness, deafnessNot faking a physical problemCannot be explained physically
36Hypochondriasis & Somatization Disorders History of diverse physical complaints of all varieties (all body systems)Focus on numerous symptomsMany trips to doctor, many medications, no root cause foundHypochondriasisPreoccupation with fear that he/she has a serious diseaseBased on the misinterpretation of bodily symptomsMountain out of a molehillNo evidence of illness
37IV. Dissociative Disorders Dissociation…the human mind’s capacity to mediate complex mental activity in channels split off from or independent of conscious awarenessA way of managing anxiety and stress…Psychogenic/Dissociative Amnesia & FugueDissociative Identity Disorder
38Amnesia & Fugue PSYCHOGENIC AMNESIA PSYCHOGENIC FUGUE Inability to recall certain personal information, which is still know at the unconscious levelLoss in episodic memory, not procedural or semanticPSYCHOGENIC FUGUELoss of memory accompanied by an actual flight from one’s present life situation to a new environmentMay take on a new identity
39Dissociative Identity Disorder Previously known as Multiple Personality DisorderIndividual manifests at least two or more distinct systems of identityHost personality + Alter identities (15)Associated with childhood abuseRare disorder; Popular in mediaCan be faked or influenced by therapist
40V. SchizophreniaCharacterized by confused and disordered thoughts and perceptionsMost debilitating of the mental disorders; Deterioration of adaptive behaviorSubtypes:ParanoidDisorganizedCatatonicUndifferentiated
41Schizophrenia…symptoms Bizarre behaviors (catatonia, others)Affect (inappropriate, flat)DelusionsSpeech (disorganized, incoherent)HallucinationsInability to care for self or functionNegative symptoms
42Positive vs. Negative Sx POSITIVE SYMPTOMSPresence of something abnormalExamples:NEGATIVE SYMPTOMSAbsence of something normal
43Schizophrenia… DELUSIONS HALLUCINATIONS False beliefs maintained in the face of contrary evidenceTypes: Grandeur IdentityPersecution ReferenceHALLUCINATIONSSensations in the absence of external stimuliTypes: visual, auditory, tactile, olfactory, gustatory
44Causes of Schizophrenia Genetic PredispositionTwin study evidenceNeurotransmittersDopamine hypothesisBrain Structure & FunctionFamily & InteractionsDouble-bind theorySchizophrenogenic mother
46VII. Other Axis I Disorders Eating DisordersSleep DisordersDisorders of childhood and adolescenceAutism, ADHD, Tourette’s, Conduct DisorderSexual and Gender Identity DisordersCognitive DisordersImpulse Control DisordersAdjustment Disorders
47VIII. Personality Disorders Diagnosed on Axis IIStem from the gradual development of inflexible and distorted personality and behavioral patterns that result in persistently maladaptive ways of relating to the worldEgo-syntonic…not a problem for the personA problem for othersResistant to treatment (only behavioral)FOCUS Antisocial, Narcissistic, OCPD
48Symptoms 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 detailsexcessive devotion to work, to the detriment of social and family activitiesmiserliness or a lack of generosityperfectionism that interferes with task completion, as performance is never good enoughrefusal to throw anything away (pack-rat mentality)rigid and inflexible attitude towards morals or ethical codeunwilling to let others perform tasks, fearing the loss of responsibilityupset and off-balance when rules or routines disrupted.
49Psychopathology & The Law Competence to Stand TrialCan individual participate in own defense at time of trial?Involuntary Civil CommitmentShould individual be hospitalized against their will due to imminent danger?Suicidal or homicidalDecided by doctor, then court; need evidence
50More Legal Issues…State-level Insanity PleaShould individual not be held accountable due to their mental state at the time of the crime?Could not determine right from wrongDetermined by judge before actual trialDifficult to prove, but prevalent in mediaSent for treatment, then released*Insanity is a LEGAL term…!
51More Legal Issues…State-level Guilty but Mentally IllAlternative to insanity plea in some statesAdopted by Pennsylvania…1st trial determines guilt or innocence2nd trial determines sanity or insanitySent for treatment, then to prison to complete sentence…get treatment as well as punishment
52TYPES 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.
53TYPES OF PSYCHOTHERAPY 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.
54TYPES OF PSYCHOTHERAPY 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.
55TYPES OF PSYCHOTHERAPY 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.
56TYPES OF PSYCHOTHERAPY 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.
57TYPES OF PSYCHOTHERAPY 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.