Psychological Disorders

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Psychological Disorders
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Four Modules

• Intro to Psych Disorders
• Anxiety, Dissociative, and Personality Disorders
• Mood Disorders
• Schizophrenia
• (Treatment of these disorders will be discussed
  in the final three modules.)

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INTRODUCTION to Psychological Disorders
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Defining abnormality

• How would you define a psychological disorder?

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Defining abnormality

• Psychological Disorder
• harmful dysfunction in which behavior is judged
• atypical- statistically and/or culturally
• disturbing- distress and suffering
• maladaptive- harmful breakdown of cognitive,
  behavioral, emotional systems

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Understanding Pathology
Description
Study of Psychological Disorders
Causation
Treatment/Outcome
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Causes of Psychopathology

• Historically Discovery Channel Video Segment
  (McGraw Hill purple DVD)
• Currently biopsychosocial model

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Psychological Disorders

• Bio-psycho-social Perspective
• These factors interact to cause psychological
  disorders
• Contrast with medical model

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Classifying Disorders

• DSM-IV
• Diagnostic system for classifying psychological
  disorders
• Various classes of disorders anxiety, mood,
  dissociative, etc.

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Potential problem of Diagnosis

• Labels
• Rosenhan study
• What is impact of labeling on people?
• ADHD, for example

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Using diagnosis on the job

• Cop Psychiatrists (Sci Amer -- segment 33)

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Rates of Disorders

• Prevalent around the world (450 million, WHO)
• 1 in 6 Americans
• Higher in those below poverty line
• Gender differences depending on disorders

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Anxiety Disorders

• Videos Psychology The Human Experience Modules
  36 37
• Obsessive-Compulsive Disorder
• characterized by unwanted repetitive thoughts
  (obsessions) and/or actions (compulsions)
• Generalized Anxiety Disorder
• Constant tension unfocused, unproductive
  chronic worry ANS arousal
• Panic attacks
• Phobia
• persistent, irrational fear of a specific object
  or situation
• e.g., social phobia

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Causes of Anxiety Disorders

• Interaction of factors
• Socio-cultural (culture of fear?)
• Psychological
• Behavioral (CC OC)
• Cognitive (interpretation of harmless situations
  as threatening)
• Biological
• Heritability twin studies
• GABA
• in OCD, frontal lobe overactivity involved with
  directing attention

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Dissociative Disorders

• Amnesia (e.g., fugue)
• Dissociative Identity Disorder (DID)
• Controversy
• Causes

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Personality Disorders

• Personality Disorders
• inflexible and enduring behavior patterns that
  impair social functioning
• e.g., borderline, antisocial (next slide)

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Anti-Social Personality Disorder

• Long Histories of
• Impulsivity / failure to plan ahead
• Aggressiveness / violating rights of others
• Lack of remorse
• Consistent irresponsibility deceitfulness
• Childhood antecedents (e.g., habitual lying,
  theft, vandalism, torturing animals)

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Neurobiological influences

• ASPD and criminality run in families
• Fearlessness Hypothesis
• Fail to show normal fear
• Fail to avoid punishment
• Under-arousal Hypothesis (see study on next
  slide)

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Arousal level in boys (as a predictor of
criminality)
Those with later convictions have lower levels of
arousal
15 10 5 0
Adrenaline excretion(ng/min)
Nonstressful situation
Stressful situation
No criminal conviction
Criminal conviction
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Mood Disorders
Mania
Video Psychology The Human Experience Module 38
Depression
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(No Transcript)
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Depression

• Clinical depression can present with a variety of
  symptoms, however almost all patients display a
  marked change in mood, a deep feeling of sadness,
  and a loss of interest or pleasure in favorite
  activities Other symptoms include
• Persistent sad, anxious, or "empty" mood
• Loss of appetite and/or weight loss, or
  conversely overeating and weight gain
• Insomnia, early-morning awakening, or
  oversleeping
• Restlessness or irritability
• Feelings of worthlessness, inappropriate guilt,
  helplessness
• Feelings of hopelessness, pessimism
• Difficulty thinking, concentrating, remembering,
  or making decisions
• Thoughts of death or suicide or attempts at
  suicide
• Loss of interest or pleasure in hobbies and
  activities that were once enjoyed, including sex
• Decreased energy, fatigue, feeling "slowed down"
  or sluggish
• Persistent physical symptoms that do not respond
  to treatment

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Depression Rates, course, and outcomes

• High prevalence and frequent relapse and
  recurrence amplify the public health significance
  of major depressive disorder (MDD).
  Epidemiological estimates place the lifetime
  prevalence of MDD at more than 16 (Kessler,
  Berglund, Demler, Jin, Walters, 2005), and 14
  of primary-care patients meet criteria for a
  major depressive episode (MDE Ansseau et al.,
  2004). The large majority of individuals with MDD
  experience more than one MDE (Judd, 1997 Mueller
  et al., 1999), and the probability of another MDE
  increases with each relapserecurrence (Solomon
  et al., 2000 American Psychiatric Association,
  2000a). For example, perhaps 85 of people who
  recover from an MDE will experience a second MDE
  within 15 years of naturalistic follow-up, and
  each additional episode increases the risk of
  relapserecurrence by 18 (Mueller et al., 1999).
  Consequently, life interference (e.g., lost work
  productivity, mortality, lower quality of life)
  due to MDD rivals that of other chronic diseases
  such as cancer, diabetes, and heart disease
  (Murray Lopez, 1996 Simon, 2003), and most
  people who commit suicide are depressed (Fawcett,
  1993).
• Vittengl et al., JCCP, Vol 75(3), Jun 2007. pp.
  475-488.

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Depression subtypes

• Post-partum
• Seasonal affective disorder

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Depression rates
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Bipolar Disorder
Mania
Major Depression
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Mania
Mania is generally characterized by a distinct
period of an elevated, expansive or irritable
mood state. People commonly experience an
increase in energy and a decreased need for
sleep. A person's speech may be pressured, with
thoughts experienced as racing. Attention span is
low and a person in a manic state may be easily
distracted. Judgment may become impaired, the
sufferer may go on spending sprees or engage in
behavior that is quite abnormal for them. They
may indulge in substance abuse, particularly
alcohol or other depressants, cocaine or other
stimulants, or sleeping pills. Their behavior may
become aggressive or intrusive. People may feel
they have been "chosen", or are "on a special
mission", which are considered grandiose or
delusional ideas. Sexual drive may increase. At
more extreme phases, a person in a manic state
can begin to experience psychosis or a break with
reality, where thinking is affected along with
mood. Many people in a manic state experience
severe anxiety and are very irritable (to the
point of rage), while others are euphoric and
grandiose.
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Rates and Course of Bipolar Disorder

• 2 4
• Highly recurrent and debilitating
• Multiple impairments in school, work, and
  relationships
• Role of psychosocial stressors
• High expressed-emotion in the family

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Mood Disorders- Suicide
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Mood Disorders Causes

• Biological

• Family studies show a 2-3 X risk (Twin studies
  MZ vs DZ twins -- 3 X risk)
• NT imbalance (e.g., dopamine and serotonin)
• Limbic-cortical dysfunction

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Mood Disorders Causes

• Psychological (stressful life events, learned
  helplessness, attributions, familial
  expressed-emotion)
• Socio-cultural (erosion of social support
  increase in multi-tasking technologies???)

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Cognitive-behavioral explanation for depression
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Schizophrenia

• Schizophrenia
• Video Psychology The Human Experience Module
  39
• split mind
• severe psychotic disorder characterized by
• disorganized and delusional thinking (e.g., Lena)
• hallucinations (e.g., Terri)
• inappropriate emotions and actions

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Rates and Course

• About 1 in 100
• Course
• Onset late teens 30s earlier in men than
  women (who have a more favorable course)
• Prognosis
• Chronic, debilitating disorder for some
• Multiple hospitalizations
• 10-15 will commit suicide
• Many others do not show a progressive
  deterioration, but stabilize over the years

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Causes

• Biological

• Neurobiological Influences
• Increased dopamine activity
• Maternal virus during pregnancy (All in the Mind
  Podcast, Nov 3, 2007 start at 450)
• Increased Risk Based on Genetic Relatedness
  (next slide)

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Runs in families
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Brain Factors

• Several brain regions have abnormalities
• E.g., Ventricle Enlargement

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Psychosocial and cultural factors

• Social drift
• Stress and relapse
• Communication patterns (high E.E.)
• Cultural acceptance vs. stigmatization