Notes Unit XII Modules 65-69

Notes Unit XII Modules 65-69

Module 65 Introduction to Psychological Disorders

World Health Organization (WHO) says 450 mill people have mental disorders

Depression/Schizophrenia are very common.

“Appear more consistently rates of disorders vary by culture.”

Defining Psych Disorders:

A disorder- is a syndrome marked by clinically significant disturbances in an individual’s cognition, emotion regulation, or behavior.

Maladaptive-

Disturbed or dysfunctional

Interferes with normal day to day life.

Controversy- disorders are sometimes dependent on culture.

Mental disorders determination or diagnosis are subjective example homosexuality was a disorder till 1973. Today we think of HDHD in similar terms…

Understanding Psychological Disorders p. 651

Early treatment and understanding was attributed to super natural forces.

Treatment was abusive, beatings, burning, castration, dunking in cold water etc…

The Medical Model:

Philippe Pinel died 1820’s

Reformer in France

Started reforms in hospitals

Argued “abnormal behavior is disease of the mind.”

Moral Treatment

1.  Boost morale

2.  Treatment is more humane

3.  Gentle

4.  Activity vs. Isolation

5.  Clean air/sunshine

Today we use the Mental Model

Mental Illness = psychopathology

Includes:

Mental Illness

Diagnosis

Symptoms

Treatment/Therapy

Hospitals

Biopsychosocial Approach

Nature-Genetic and Physiological causes

Nurture- Experience/conditioning/social factors

Culture and Mental Illness

Cultural issues relate, for example Anorexia/bulimia are found in Western cultures.

Running Amok- in Malesia

Susto- Latin America, severe anxiety, restlessness, fear of black magic.

Taijin- Kyofusho- social anxiety, fear of eye contact

Hikikomori (Japan) extreme withdrawal

Classifying Psychological Disorders

Classification-

DSM-5 Organizes and describes Symptoms

Diagnostic Criteria for mental disorders

Defines criteria= frequency, causes, duration, multiple symptoms, treatment options

Example Insomnia Disorders

Revisions are made regularly

Bias and Labeling Psychological Disorders

Labels- problem when a label is given it creates expectancy and preconceptions

Preconceptions guide our perceptions and attitudes. We judge and change our behavior when we get information, also creates prejudice

Experiment-Bias of Labels

Rosenhan 1973

Patients misdiagnosed with mental disorder were held 19 days

Stereotypes were reinforced.

Rates of Psychological Disorders P 657

1.  US + Ukraine highest

2.  Nigeria, Italy, Shanghai least

P 658

1.  Predictor of mental disorder

1. Poverty correlation
2. Poverty can have an exacerbating effect

Onset of Mental Disorders

1.  Usually in early adulthood for most disorders manifest mostly by age 24

2.  Antisocial Personality Disorder and phobias emerge ages 8-10

3.  Alcohol use Disorder – emerges around age 20

4.  OCD, Bipolar, Schizophrenia, and Major Depression- all emerge around age 25.

Module 66 Anxiety Disorders, Obsessive-Compulsive Disorder, and Post-traumatic Stress Disorder

Often caused by fear of future loss.

Anxiety

·  Uneasiness

·  Tense- intense dread/fear

·  Distressing

·  Persistent Anxiety

·  Dysfunctional anxiety reducing behavior (maladaptive coping behaviors of drugs and alcohol)

Generalized Anxiety

·  Unexplained

·  Continual

·  Tense and uneasy

Panic Disorder

·  Sudden episodes

·  Creates intense dread

Phobias

·  Intense

·  Irrationally afraid of specific object or situation

Obsessive Compulsive Disorder

·  Repetitive thoughts or actions

Post-Traumatic Stress Disorder

·  Lingering memories

·  Nightmares

·  For weeks

·  Uncontrollable

Generalized Anxiety

·  Unfocused

·  Out of control

·  Agitated feelings

·  Pathological worry

·  Persistence 6 months or more

·  2/3 are women

·  Jittery/agitated

·  Sleep deprived

·  Cause many not be easily identified

·  Also with depressed mood

·  High blood pressure

·  Childhood causes- maltreatment,

·  By age 50 relatively rare

P 662

Panic Disorder (Anxiety)

·  Panic attack

·  Physical manifestations

·  Heart beat

·  Shortness of breath

·  Choking sensation

·  Trembling

·  Dizziness

Phobias

·  (Anxiety disorder)

·  Irrational fear

·  Causes person to avoid 1. Object 2. Activity 3. Situation

Social Anxiety Disorder

·  Shyness to an extreme

·  Fear of being scrutinized by others

·  Worries about anxiety

Agoraphobia

·  Fear or avoidance of public crowds/public situations

Obsessive Compulsive Disorder

·  Being obsessed with thoughts that will not go away

·  Maladaptive

·  2/3 %

·  Often @ late teens

·  Young people and adults

Post-Traumatic Stress Disorder

·  250,000 US Vets have been diagnosed with PTSD or Traumatic Brain Injury

·  Characterized by

·  Emotional traumatic experiences

·  Social Withdrawal

·  Nightmares

·  Jumpy anxiety

·  Insomnia

·  1 in 6 people in combat report either PTSD/Depression/severe anxiety

Brain Areas

·  Amygdala- emotion

·  Temporal lobe = memory

·  Genetic predisposition

Resiliency- lots of people don’t experience PTSD even with lots of trauma

Understanding Anxiety Disorders

Learning/Conditioning

Conditioned fear through Classical and Operant conditioning

People become hyper-attentive to threats

They associate anxiety with certain cues/stimuli

·  Stimulus generalization

·  Reinforcement

·  Avoidance

·  Observational learning

·  We learn fear through observing others in fear

o  Monkeys and fear of snakes

Cognition

·  Irrational beliefs

·  Hyper vigilance

·  Intrusive thoughts

Biological Perspective

1. Evolutionary/Genetic

2.  Anxiety genes

3.  Coping genes

4.  Neurotransmitters

1. Serotonin (related to genes)
2. Glutamate - too much = anxiety

The Brain and Anxiety

“As an over arousal of brain areas involved in impulse control and habitual behaviors.”

·  OCD

·  Anterior cingulate cortex

·  Region monitors our actions and checks for errors

·  Is hyperactive

·  Frontal lobe

Module 67 Mood disorders p 671

Definition of Mood Disorders

Psych disorders characterized by emotional extremes

Two major types of Mood Disorders:

Major Depressive Disorder

Prolonged hopelessness
Lethargy
Depressive symptoms:
Feeling deeply discouraged about the future
Dissatisfied with life
Feeling socially isolated
Lack energy to get things done
May not have energy to get out of bed
May be unable to concentrate, eat, sleep,
Thoughts of suicide
Social Stresses
Often caused by a response to past and current loss, death, marital disruption, lost job…
Ruminative thinking /

Bipolar Disorder (less common than depression)

Formerly called Manic Depressive
A person alternates between depression and mania (an overexcited, hyperactive state, euphoric, hyperactive, wildly optimistic)
Alternating between depression and mania week to week (not day to day)
·  Issue of lots of diagnosis for adolescent boys. Which will be remedied by new classification
During Manic Phase:
Overtalkative
Overactive
Elated
Have little need for sleep
Show less sexual inhibitions
Reckless/poor judgment
(some connection of mania to creativity)
Famous Bi-polar:
Fredric Handel, Schuman,
Composers, artists, poets, novelists, and entertainers seem especially prone
Mania is followed by depressive episode

Depression is the number one reason people seek mental health services

Stats say, depression is affects 17% of US adults.

Depressive Episode plagues 5.8% of men and 9.5% if women

Depression as an evolutionary interpretation-

“it protects the psyche. It slows us down, defuses aggression, helps us let go of unattainable goals, and restrains risk taking…”

“Redirects energy in more promising ways”

Persistent Depressive Disorder (AKA dysthymia)

Characteristics:

Mildly depressed mood more often than not, for a least 2 years.

Also at least two of the following symptoms:

1.  Problems regulating appetite

2.  Problems regulating sleep

3.  Low energy

4.  Low self-esteem

5.  Difficulty concentrating and making decisions

6.  Feelings of hopelessness

Understanding Mood Disorders:

Behavioral and Cognitive changes come with Depression:

Negative thinking

Behavioral aspects could include anxiety and substance abuse (self-medicating)

Depression is widespread

Women risk of major depression is nearly double to men 13% men/22% Women

Most major depressive episodes self-terminate

Therapy helps, but most people eventually recover on their own.

Stressful events related to work, marriage, and close relationships often precede depression.

Stressful incidents correlate with depression

Death/marital crisis, physical assault- related to depression

More younger people are experiencing depression

Perhaps more reporting of depressive feelings.

Biological Perspective

Genetic Influences:

Mood disorders runs in families, risks increase with a family member who manifests behavior

Twin studies really show this

Close-up-

Suicide

1 million people worldwide take their own life

Racial differences- whites 2xs more often as blacks

Gender differences- women more likely to attempt, men more likely to complete the job.

Age differences-late adulthood increases/ peaks at middle age

Group differences- higher rate among rich/non religious/single/widowed/divorce/gay and lesbian youth

Wednesdays are bad.

Correlation with depression, when people are coming out of a depressive episode

Correlation with alcohol disorder

Suicide can be reduced by- jump barriers/unavailability of loaded guns

Social Suggestion may trigger suicide-publicity

Associated with the need to connect and belong/the failure to achieve a big goal..

Suicidal people give hints- giving possessions away, verbal hints, preoccupation with death

Sometimes a suicide attempt is a plea for help.

·  “So, if a friend talks suicide to you, it’s important to listen and to direct the person to professional help. Anyone who threatens suicide is at least sending a signal of feeling desperate or despondent.”

Self-Injury: Non-suicidal self-injury (NSSI)

Adolescents

Cutting/burning/hitting/pulling hair

More females than males

Thoughts- extremely self-critical, poor communication/poor problem solving

Relieves negative thoughts through distraction

Gain attention

Relieve guilt by self-punishment

The Depressed Brain:

Neurotransmitters

Norepinephrine- increases arousal/boosts mood/ scarce during depression (smoking increases)

Serotonin- creates euphoria, diminished serotonin associated with depression (SSRI selective Serotonin Reuptake Inhibitor)

Diminished brain activity in depressive mood left frontal

Brain size depressed people smaller frontal lobes

Hippocampus with stress related damage

Pet scans

Exercise increases serotonin

Alcohol increases depression

Social Cognitive Perspective

The role of thinking and acting in depression

Low self esteem

Negative thought patterns/their future

Catastrophizing

Minimizing the positive

Negative Thoughts and Negative Moods

Learned helplessness, more common in women, stress association,

Over thinking, ruminating,

Negative Explanatory Style

Martin Seligman-

depression researcher, said, “individualism and the decline of commitment to religion and family have forced young people to take personal responsibility for failure or rejection.”

Depression’s Vicious Cycle

The vicious cycle of depressed thinking Cognitive therapists attempt to break this cycle, as we will see in Module 71, by changing the way depressed people process events. Psychiatrists attempt to alter with medication the biological roots of persistently depressed moods

Module 68 Schizophrenia

1. Describe the patterns of thinking, perceiving, and feeling that characterize schizophrenia.
2. Contrast chronic and acute schizophrenia.
3. Discuss how brain abnormalities and viral infections help explain schizophrenia.
4. Discuss the evidence for genetic influences on schizophrenia, and describe some factors that may be early warning signs of schizophrenia in children.

Introduction:

Maxine- a schizophrenic, delusions…

Nearly 1 in 100 people, 60% men develop schizophrenia

24 million across the world

Symptoms of Schizophrenia

Definition of Schizophrenia:

Means “split mind”/relates to “split from reality” characterized by disturbed perceptions, disorganized thinking and speech, diminished/inappropriate emotions. “Psychosis- irrationality and lost contact with reality”

Disorganized Thinking and Disturbed Perceptions:

·  Thinking is Fragmented and bizarre, distorted by false beliefs/delusions (false thoughts)

·  Some paranoid tendencies/delusions of persecution

·  Word Salad- jumbled words/sentences

·  Hallucinations are common/sensory experiences without sensory stimulation

·  See/feel/taste/smell/voices/barking out insults/cursing

·  The unreal seems real

·  (issue of malfunction of “Selective Attention”/distraction

Diminished and Inappropriate Emotions

(Book Living With Schizophrenia)

Expressed emotions are usually inappropriate

Sometimes they react with flat affect

Motor behavior may be inappropriate.

Compulsive acts/rocking/rubbing an arm

Catatonia- remaining motionless for hours

Many people with schizophrenia have extreme difficulty

With medication, they can function, but many cannot.

Onset and Development of Schizophrenia

Typically strikes young people/adolescent onset

More men and more severely

Chronic Schizophrenia or Process Schizophrenia

Sometimes it’s gradual onset,

Recovery is doubtful

Exhibits negative symptoms/social withdrawal

Men who develop schizophrenia early

Acute or Reactive Schizophrenia

Sometimes it’s sudden onset

Due to life stresses

Recovery is more likely

Reflect positive symptoms

Respond well to medication

Positive Symptoms-

·  Presence of inappropriate behavior

·  hallucinations/talk in disorganized ways/inappropriate laughter

Negative Symptoms-

·  Absence of appropriate behaviors

·  toneless voices/expressionless faces/mute/rigid bodies

Understanding Schizophrenia:

Brain Abnormalities

Brain manifestation of Schizophrenia

Brain abnormalities

Low activity in frontal lobe

Problem with integrated function/connectivity

Hallucinations show activity in thalamus

Paranoia shows activity in the amygdala (emotion and fear)

Brain Structures:

Enlarged fluid-filled areas

Shrinkage and thinning of cerebral tissue

Shrinkage of thalamus

Shrinkage of Cortex

Shrinkage of corpus collosum

Genetic predispositions

Biochemical Connections

·  Dopamine Overactivity

·  Excessive receptors for dopamine found in brains of schizophrenics (6 times as many)

·  Causes hallucinations and paranoia (too much dopamine)

Causes of Schizophrenia:

Correlation/fetal-virus infections play a contributing role

Genetic Factors

Twin Studies show strong correlation

Family studies show strong correlation too

Psychological Factors

Module 69 Other Disorders

·  Somatic

·  Dissociative

·  Eating

·  Personality

Somatic Symptoms and Related Disorders

Medically unexplained illnesses

No physical cause of illness identified

Could be unconscious psychological origin

Somatic Symptom Disorder

“symptoms are psychological in origin.”

Conversion Disorder

·  AKA “Functional Neurological Disorder”

·  Anxiety is converted into a physical symptom

·  Freud tried to explain this

·  Unexplained paralysis

·  Unexplained blindness

·  “inability to swallow”

Illness Anxiety Disorder

·  (AKA Hypochondriasis)

·  Relatively common

·  People interpret trivial normal sensations as symptoms of a terrible disease

·  Sympathy

·  Temporary relief from daily pressure

·  Reinforce complaints

·  Patients commonly sees multiple doctors.

Dissociative Disorders:

·  Rare

·  Disorder of consciousness

·  Sudden loss of memory

·  Or change in identity

·  Often in response to overwhelming stressful situation

Dissociative Identity Disorder

Fugue State

·  A person’s conscious awareness is said to dissociate (become separated)

·  From painful memories, thoughts, feelings

·  Amnesia

·  Short lived

·  Unplanned travel is common for Fugue reports

·  Sometimes new identity

·  Memory comes back

Dissociative Identity Disorder p 695

·  D.I.D. (formerly multiple personality disorder)

·  Dissociation of the self from ordinary consciousness

·  “In which two or more distinct identities are said to alternately control the person’s behavior.”

·  Each personality has its own voice + mannerisms

·  The original personality usually denies the awareness of the others

Understanding D.I.D.

·  Some evidence it is a cultural phenomenon

·  No Japan

·  No India

·  Are people acting out fantasies?

Some researchers see it as a real disorder

·  Evidence- brain and body states

·  Handedness sometimes switches with personality

·  Shifted visual acuity

·  Shifting activity in brain areas control of inhibitions

D.I.D. and Psychodynamic approach

Say DID is way of dealing with anxiety

Unacceptable impulses push a new personality able to act on forbidden impulses