Psychological Disorders

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• Chapter 13
• Psychological Disorders

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Psychological Disorders

• Psychological Disorder
• a harmful dysfunction in which behavior is
  judged to be
• atypical--not enough in itself
• disturbing--varies with time and culture
• maladaptive--harmful
• unjustifiable--sometimes theres a good reason

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Psychological Disorders

• Medical Model
• concept that diseases have physical causes
• can be diagnosed, treated, and in most cases,
  cured
• assumes that these mental illnesses can be
  diagnosed on the basis of their symptoms and
  cured through therapy, which may include
  treatment in a psychiatric hospital

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Psychological Disorders

• Bio-Psycho-Social Perspective
• assumes that biological, sociocultural, and
  psychological factors combine and interact to
  produce psychological disorders

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Psychological Disorders
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Classifying Psychological Disorders

• DSM-IV
• American Psychiatric Associations Diagnostic and
  Statistical Manual of Mental Disorders (Fourth
  Edition)
• a widely used system for classifying
  psychological disorders
• presently distributed as DSM-IV-TR (text revision)

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Classifying Psychological Disorders

• DSM-IV
• Changes with time
• New advances in scientific understanding
• New cultural definitions of normalcy
• E.g., homosexuality
• So, disorders are often at least partly a result
  of societal expectations

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Anxiety Disorders

• Anxiety Disorders
• distressing, persistent anxiety or maladaptive
  behaviors that reduce anxiety
• Generalized Anxiety Disorder
• person is tense, apprehensive, and in a state of
  autonomic nervous system arousal
• Feel others are against you
• Feel disagreement is an attack
• Hypersensitive to conflict
• Reluctant to examine own imperfections

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Anxiety Disorders

• Panic Disorder
• marked by a minutes-long episode of intense dread
  in which a person experiences terror and
  accompanying chest pain, choking, or other
  frightening sensation

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Anxiety Disorders

• Phobia
• persistent, irrational fear of a specific object
  or situation
• Like PTSD perhaps chronically sensitive amygdala

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Anxiety Disorders

• Obsessive-Compulsive Disorder
• unwanted repetitive thoughts (obsessions) and/or
  actions (compulsions)

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Anxiety Disorders

• PET Scan of brain of person with obsessive-
  compulsive disorder
• High metabolic activity (red) in frontal lobe
  areas involved with directing attention

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Anxiety Disorders

• Common and uncommon fears

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Anxiety Disorders
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Dissociative Disorders

• Dissociative Disorders
• conscious awareness becomes separated
  (dissociated) from previous memories, thoughts,
  and feelings
• Dissociative Identity Disorder
• rare dissociative disorder in which a person
  exhibits two or more distinct and alternating
  personalities
• formerly called multiple personality disorder

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Personality Disorders

• Personality Disorders
• disorders characterized by inflexible and
  enduring behavior patterns that impair social
  functioning
• usually without anxiety, depression, or delusions

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Personality Disorders

• Antisocial Personality Disorder
• disorder in which the person (usually man)
  exhibits a lack of conscience for wrongdoing,
  even toward friends and family members
• may be aggressive and ruthless or a clever con
  artist

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Mood Disorders-Depression

• Boys who were later convicted of a crime showed
  relatively low arousal

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Personality Disorders

• PET scans illustrate reduced activation in a
  murderers frontal cortex

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Mood Disorders

• Mood Disorders
• characterized by emotional extremes
• Major Depressive Disorder
• a mood disorder in which a person, for no
  apparent reason, experiences two or more weeks of
  depressed moods, feelings of worthlessness, and
  diminished interest or pleasure in most activities

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Mood Disorders

• Manic Episode
• a mood disorder marked by a hyperactive, wildly
  optimistic state
• Bipolar Disorder
• a mood disorder in which the person alternates
  between the hopelessness and lethargy of
  depression and the overexcited state of mania
• formerly called manic-depressive disorder

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Mood Disorders

• Mood disorders are also called affective
  disorders.
• Affect emotion
• Two poles to mood
• up or manic
• down or depression
• excess focus on one pole or the other is
  pathological
• Manic-depression (bipolar)

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Mood Disorders

• Balance between frontal lobe and emotional system
• Especially amygdala

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Personality Disorders

• PET scans illustrate reduced activation in a
  murderers frontal cortex

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Mood Disorders

• Richard Davidson
• Our research
• Depressed people cant plan or concentrate well
• Ruminate about their fears
• Executive in frontal lobe decreased?
• Most tests say no, depressed people can do them
• So what part of executive function affected?

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Mood Disorders

• In depression frontal-amygdala balance goes out
  of adjustment
• Left frontal most important (pos-neg)
• Also important to brain maturation and
  personality maturation
• Also criminal behavior

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Mood Disorders

• Survey in 1990s cause of depression
• 71 due to emotional weakness
• 65 caused by bad parenting
• 45 victims fault
• 43 incurable (???)
• 35 consequence of sinful behavior
• 10 biological basis, involves brain

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Mood Disorders

• Diagnosis
• how do you distinguish between a temporary,
  rather normal mood and clinical depression which
  should be treated?
• Diagnostic and Statistical Manual of Mental
  Disorders (DSM-IV)
• International Classification of Diseases (ICD-10)
• Difficulties in diagnosis for example
  comparison of schizophrenia diagnosis in US and UK

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Mood Disorders

• Affective disorders are SYNDROMES
• a collection or cluster of symtoms
• mood quality
• duration, intensity, valence
• vegetative features
• sleep, appetite, weight, sex drive
• cognitive features
• attention span, frustration tolerance, memory,
  negative distortions
• executive dysfunction, planning, rumination
• impulse control
• suicide and homicide
• behavioral features
• motivation, pleasure, interests, fatigability
• physical features
• headaches, stomach aches, muscle tension

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Mood Disorders

• DSM IV criteria for depression episode
• depressed mood most days
• diminished interest or pleasure most days
• significant weight loss or gain

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Mood Disorders

• DSM IV criteria for depression episode (cont)
• insomnia or hypersomnia most days
• psychomotor agitation or retardation most days
  (external observation)
• fatigue or loss of energy most days

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Mood Disorders

• DSM IV criteria for depression episode (cont)
• feelings of worthlessness or excessive/inappropria
  te guilt
• diminished ability to think or concentrate (about
  things other than difficulties)
• recurrent thoughts of death (not fear of dying),
  suicidal ideation without plan, a plan or attempt

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Mood Disorders

• 5 present for 2 weeks (must include 1 or 2)
• change from previous function
• symptoms impair function (in social,
  occupational, etc.) or cause clinically
  significant distress
• not result of substance
• not bereavement

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Mood Disorders

• Suicide committed by up to 15 (1 mo)
• Attempts 1/10 (1 year depressed)
• success 1/100 (1 year depressed)
• 1/7 with recurrent depression
• 5 to 11 will be depressed at some point
• Episodes can last years
• Long lasting depression has high morbidity from
  suicide
• 70 of suicides have depressive illness
• 20 40 of patients consider or attempt suicide
  (nonfatal)
• 16,000 suicides per year (30,000)
• 15 of those hospitalized

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Mood Disorders

• Untreated, most episodes last 6 24 months
• Three Rs
• response to treatment
• decrease of gt 50 on Hamilton Depression Rating
  Scale or other (Beck, SKID, MMPI)
• remission
• all symptoms go away
• recovery
• remission for gt 6 mos
• Two Rs
• relapse
• worsening before remission or recovery
• recurrence
• worsening a few months after recovery

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Mood Disorders

• TREATMENT
• Depression
• 2/3 response rate to a given medication
• 1/3 respond to placebo
• 40 still ill after 1 year treatment, 40
  recovered, 20 dysthymic
• THE GOOD NEWS
• Up to 90 response if multiple medications and
  combinations are tried
• up to 50 of responders remit w/in 6 mo
• 2/3 w/in 2 yrs
• Medication reduces incidence of relapses during
  1st year after response
• ½ relapse if switched to placebo
• 10 if not

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Mood Disorders

• DSM-IV criteria for manic episode
• period of abnormally and persistently elevated,
  expansive, or irritable mood
• at least 1 week in duration
• three or more of the following
• inflated self-esteem or grandiosity
• decreased need for sleep
• more talkative than usual pressure to keep
  talking
• racing thoughts, flights of ideation
• distractable
• increased goal-seeking activity
• risky pleasure seeking (spending, sexual,
  business, etc.)
• impairs functioning
• not from substance

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Mood Disorders-Depression
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Mood Disorders- Suicide
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Mood Disorders-Bipolar

• PET scans show that brain energy consumption
  rises and falls with emotional switches

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Mood Disorders-Depression

• Altering any one component of the
  chemistry-cognition-mood circuit can alter the
  others

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Mood Disorders-Depression

• The vicious cycle of depression can be broken at
  any point

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Mood Disorders-Depression

• The vicious cycle of depression can be broken at
  any point?
• Actually, this may not be true. Rumination
  cognitive therapies have limited success
• Stressful experiences may not be under control

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Schizophrenia

• Schizophrenia
• literal translation split mind
• Disconnection
• Thomas Szasz
• a group of severe disorders characterized by
• disorganized and delusional thinking
• disturbed perceptions
• inappropriate emotions and actions

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Schizophrenia

• Schizophrenia
• Is polar
• Seems to involve either too much or too little
  dopamine
• Gain hypothesis

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Schizophrenia

• Delusions
• false beliefs, often of persecution or grandeur,
  that may accompany psychotic disorders
• Hallucinations
• sensory experiences without sensory stimulation

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Schizophrenia
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Schizophrenia
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Schizophrenia
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Schizophrenia
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Rates of Psychological Disorders