The Psychological Disorders

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The Psychological Disorders

• What is abnormal
• Refers to maladaptive cognitions, affects, and or
  behaviors that are at odds with social
  expectations and result in distress or discomfort
• Abnormal means not of the norm or not average
• Michael Jordan
• Einstein

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Abnormal

• The reactions of people with psychological
  disorders are maladaptive
• They must be impaired somehow
• Not just strange
• May present itself in various ways
• Affect
• Behavior
• Cognition
• Social factors are also important
• Behavior at a party vs. school
• Distressing
• Psychological disorders are uncomfortable for
  those that have one as well as those around them

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Diagnostic Statistical Manual of Mental Disorders
(DSM)

• A way to classify and diagnose mental disorders.
• Lists 297 different diagnostic categories
• Does not attempt to address the causes of mental
  disorders
• It is an attempt to be as objective as possible
  in describing the symptoms of mental disorders

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Anxiety Disorders, Somatoform Disorders, and
Dissociative Disorders
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Anxiety Disorders

• Definition of anxiety
• A feeling of general apprehension or dread
  accompanied by predictable physiological changes
• Two levels
• Subjective feelings
• Dread
• Fear
• Physiological responses
• Increased muscle tension
• Shallow rapid breathing
• Cessation of digestion
• Increased perspiration
• Drying of the mouth

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Anxiety Disorders

• Major symptom of anxiety
• Feeling of anxiety coupled with avoidance
  behavior
• Attempt to avoid situations that seems to produce
  anxiety
• Most common of all the psychological disorders
• Perhaps as many as 25 of people will experience
  an anxiety disorder at some time in their lives.
• Two to three times more common in women

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Five anxiety disorders

• 1) Generalized anxiety disorder (GAD)
• Distressing felt anxiety
• Unrealistic, excessive, persistent worry
• Chronic
• An intense anxiety that is diffuse
• Not brought on by anything specific
• No clear insight to what is causing the anxiety

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2) Panic Disorder

• 1.5-3.5 of the population
• More acute than GAD
• Recurrent, unpredictable, unprovoked onset of
  sudden, intense anxiety.
• Can last from seconds to hours
• No particular stimulus to bring it on
• Age of onset is adolescence to mid twenties
• Initial attacks are often associated with stress
• Loss of an important relationship
• Often accompanied with depression
• High rate of suicide attempts 20

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3) Phobic Disorders

• A persistent and excessive fear of some object,
  activity, or situation that consistently leads a
  person to avoid it.
• No real or significant threat involved
• The fear is unreasonable
• Two main categories of phobic disorders
• Specific Phobias
• Animals
• Physical environment storms, heights
• Blood, injection, or injury
• Specific situations tunnels, airplanes
• Social phobias
• Persistent fears of social or performance
  situations in which embarrassment could occur
• Public speaking

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4) Obsessive-Compulsive Disorder (OCD)

• A pattern of recurrent obsessions and compulsions
• Obsessions
• Ideas or thoughts that involuntarily and
  constantly intrude into awareness
• Cleanliness, violence, disease, danger, doubt
• Did I turn off the stove?
• Compulsions
• Constantly intruding, repetitive behaviors
• Handwashing, grooming, counting, and checking
• Checking your alarm repeatedly to make sure it is
  set

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5) Posttraumatic Stress Disorder (PTSD)

• Distressing symptoms that arise some time after
  the experience of a highly traumatic event
• Trauma as defined by the DSM-IV
• The person has experienced, witnessed, or been
  confronted with an event that involves actual or
  threatened death or serious injury
• The persons response involves intense fear,
  helplessness, or horror.

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Symptoms of PTSD

• Re-experiencing the traumatic event
• Flashbacks
• Nightmares
• Avoidance of any possible reminders of the event
• People who were there
• Increased arousal or alertness
• Irritability
• Insomnia
• Difficulty concentrating

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Somatoform Disorders

• Disorders that involve some physical, bodily
  complaint
• Psychological disorders
• No known medical or biological cause for the
  symptoms.
• Three types
• Hypochondriasis
• Somatization disorder
• Conversion disorder

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Hypochondriasis and Somatization Disorders

• A person diagnosed with hypochondriasis is
  preoccupied with the fear of a serious disease
• Fear of a nonexistent disease
• A person with somatization disorder is
  preoccupied with nonexistent symptoms
• Really the two disorders are quite similar

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Conversion Disorder

• Loss or altering of physical function that
  suggests that there is some physical problem
• Paralysis often times of just the hand
• Glove anesthesia
• Blindness
• Deafness
• This was Freuds Hysteria
• Diagnosed much more often in Freuds time
• Why?

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Dissociative Disorders

• To dissociate means to become separate or escape
• Dissociative amnesia
• Inability to recall important personal
  information
• Beyond simple forgetfulness
• Often times it involves forgetting some traumatic
  event
• Somewhat controversial disorder
• Like repressed memories

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Dissociative Identity Disorder

• Multiple personality disorder
• Not schizophrenia which we will talk about
  later
• The existence within the same person of two or
  more distinct personalities.
• Very rare
• Most recorded cases are restricted to North
  America
• Usually this disorder occurs in patients working
  closely with a therapist

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Personality Disorders
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Personality Disorders

• These disorders represent stable abnormal
  personality characteristics that people are born
  with and are difficult to treat.

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What is a Personality Disorder?

• Personality disorder- an enduring pattern of
  inner experience and behavior that
• deviates markedly from the expectation of the
  individuals culture
• Is pervasive and inflexible
• Has an onset in adolescence or early adulthood
• Is stable over time
• Leads to distress or impairment

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What is Impaired?

• To be diagnosed with a personality disorder, one
  must exhibit behavior that is abnormal with
  respect to any two of the following
• Thinking
• Mood
• Personal relations
• The control of impulses

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The DSMs 3 Clusters of Personality Disorders

• Cluster A - Odd or Eccentric
• (paranoid, schizoid, schizotypal)
• Cluster B- Dramatic, Emotional, or Erratic
• (antisocial, borderline, histrionic,
  narcissistic)
• Cluster C- Anxious or Fearful
• (avoidant, dependent, obsessive-compulsive)

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Cluster A

• Paranoid
• Schizoid
• Schizotypal

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Paranoid

• Distrust of others, including the belief, without
  reason, that others are exploiting, harming, or
  trying to deceive them
• Belief in hidden meanings
• Unforgiving and grudge holding

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Schizoid

• Very limited range of emotion, both in expression
  of and experiencing
• Indifferent to social relationships
• Prefer solitary interests

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Schizotypal

• Peculiarities of thinking
• Odd beliefs (e.g.- belief that they have
  telepathic or magical powers)
• Eccentricities of appearance, behavior,
  interpersonal style, and thought (e.g.- I am not
  a very talkable person)
• Recurrent illusions

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Cluster B

• Antisocial
• Borderline
• Histrionic
• Narcissistic

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Antisocial

• Lack of regard for the moral or legal standards
  in the local culture
• Inability to get along with others or abide by
  societal rules
• Sometimes called psychopaths or sociopaths

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Borderline

• Problems with self-identity
• Rapid changes in mood
• Intense unstable relationships
• Impulsivity
• Instability in affect and self-image

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Histrionic

• Overly dramatic and attention seeking
• Exaggerated or inappropriate displays of
  emotional reactions, often to the point of being
  theatrical, in everyday behavior
• Unusual clothing, hairstyle, or makeup used to
  draw attention to themselves
• Overly concerned with their physical
  attractiveness and are uncomfortable when they
  are not the center of attention

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Narcissistic

• Behavior or a fantasy of grandiosity
• Relationships are disturbed because of their lack
  of empathy and feelings of envy, arrogance, and
  taking advantage of others
• A need to be admired by others
• Inability to see the viewpoints of others
• Hypersensitive to the opinions of others

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Cluster C

• Avoidant
• Dependent
• Obsessive-Compulsive

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Avoidant

• Social inhibition
• Feelings of inadequacy
• Extremely sensitive to criticism

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Dependent

• Extreme need of other people, to a point where
  the person is unable to make any decisions or
  take an independent stand on their own
• Fear of separation and submissive behavior
• Lack self-confidence

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Obsessive-Compulsive

• Perfectionism
• Inflexibility
• Preoccupation with uncontrollable patterns of
  thought and action
• Obsessive-compulsive personality disorder is NOT
  the same as obsessive-compulsive disorder
• No actual obsessions or compulsions

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Alzheimers Dementia, Mood Disorders, and
Schizophrenia
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Alzheimer's Disease

• How many get it?
• 15 of people over 65
• 35 over 85
• First signs?
• Decline in cognitive ability
• forgetfulness
• Emotional instability
• depression

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Alzheimers

• Eventually
• Total dementia
• Inability to perform even the most simple
  responses
• swallowing
• Terminal
• Definitively diagnosed by autopsy
• Amyloid plaques
• clumps of degenerating neurons
• an abnormal protein called amyloid
• Neurofibrillary tangles
• tangles of neurofibrils within neurons

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Alzheimer's Disease

• Loss of neurons is common
• Plaques, tangles and neuron loss are often most
  common in areas involved in memory such as
• Hippocampus
• Amygdala
• entorhinal cortex

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Alzheimers Disease

• Appears to be a clear genetic component
• If immediate family member has Alzheimers
• 50 chance if live into 80s
• Cholinergic neurons often die early in the course
  of Alzheimers disease
• Cholinergic agonists are effective at reducing
  symptoms early in the disease

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Mood Disorders

• Used to be called affective disorders
• Any disorder where a disturbance of the mood is
  the defining symptom
• Symptoms and Etiology
• All of us have experienced depression
• people in whom depression is so severe and so
  frequent, often without obvious cause, are said
  to be suffering from the psychiatric disorder of
  depression

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Depression is characterized by

• Despair
• Hypoactivity
• sleep problems
• Withdrawal
• lack of appetite
• an inability to care for oneself

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Mania

• The other type of affective disorder
• in many respects it is the opposite of depression
  
• patients with mania are overconfident, impulsive,
  distractible and highly energetic
• Many people who suffer from depression also
  suffer from mania
• bipolar disorder (1 of people)
• unipolar disorder (6 of people)
• depression only
• About 10 of people suffering from a mood
  disorder will commit suicide

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• Concordance rate for bipolar disorder
• identical twins about 60
• fraternal twins about 15
• thus, there is a strong genetic component
• Stress can play a major role in the etiology of
  mood disorders
• Stress can trigger attacks of depression
• 84 of a large sample of patients seeking
  treatment for depression had experienced a severe
  stress in the preceding year

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Antidepressant Drugs

• monoamine oxidase (MAO) inhibitors
• Tricyclic Antidepressants
• block the reuptake serotonin and norepinephrine
  as well as other monoamines
• safer than MAO inhibitors
• Selective serotonin reuptake inhibitors (SSRIs)
• Prozac
• a variation of tricyclic antidepressants
• selectively block serotonin uptake.
• have fewer side effects
• effective against many types of psychological
  disorders
• Recently, serotonin -norepinephrine reuptake
  inhibitors (SNRIs) have proven equally effective
  in the treatment of depression

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Monoamine Theory of Depression

• Most widely accepted theory of depression
• All the drugs are serotonin and/or norepinephrine
  agonists
• Increase the effectiveness of serotonin and
  norepinephrin
• Depression due to underactivity at serotonin and
  norepinephrine synapses?

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Diathesis-Stress Theory of Depression

• Based on the idea that some people inherit a
  diathesis (genetic predisposition) for depression
• if the individual is stressed early in life their
  systems become altered so that they are
  hypersensitive to stress for the rest of their
  lives.
• This leads to the development of depression.

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Schizophrenia

• Symptoms and Etiology
• schizophrenia literally means a splitting of
  psychic function (the shattered mind)
• characterized by a complex and diverse set of
  symptoms

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Positive vs. Negative Symptoms

• Positive
• Hallucinations
• False Perceptions
• Delusions
• False Beliefs
• Bizarre Behaviors
• Negative
• Emotional and social withdrawal
• Reduced energy and motivation
• Apathy
• Poor attention

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types of Schizophrenia

• Paranoid
• presence of auditory hallucinations
• prominant delusional thoughts about persecution
  or conspiracy
• often function well, and symptoms may not present
  until later in life
• beautiful mind

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Disorganized schizophrenia

• disorganization of thought process
• hallucinations and delusions less pronounced
• significant impairment in ability to maintain
  everyday activities
• dressing, bathing, brushing teeth
• disrupted emotions
• flattened affect
• inappropriate emotions
• laughing at funeral

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catatonic schizophrenia

• disturbance in movement
• catatonic stupor
• voluntary movement stops
• catatonic excitement
• increased movement
• may become immobile
• resist any attempt to move them
• may hold any position in which they are placed
• may voluntarily choose a contorted body position
  and stay that way for long periods of time
• echolilia
• mimic what people say
• echopraxia
• mimic what people do

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Undifferentiated and Residual

• Undifferentiated
• catch all
• this is the diagnosis when not easily classified
  into the other subtypes
• Residual
• diagnosed when patient is no longer displaying
  prominent symptoms
• some patients wax and wan though varying degrees
  of illness

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Cause of Schizophrenia?

• About 1 of the population is schizophrenic
• the incidence appears to be about the same in all
  parts of the world
• A genetic basis
• the concordance rate of schizophrenia in
  identical twins is about 45
• in fraternal twins or sibs it is about 10

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Cause of Schizophrenia?

• Experiential Factors
• prenatal trauma
• Nutritional deficiency
• Infection
• stress
• Clearly schizophrenia is influenced by both
  genetics and experience
• the current view is that people inherit a
  predisposition for schizophrenia which may or may
  not be activated by experience

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Dopamine Theory of Schizophrenia

• Chlorpromazine and Reserpine
• quite different from each other in terms of
  chemical structure
• Effects were very similar
• Didnt start working for 2 or 3 weeks
• Both drugs started to produce side effects
• mild tremors at rest
• muscular rigidity
• a decrease in voluntary movement
• symptoms of Parkinson's disease

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Dopamine Hypothesis

• Parkinsons patients have a deficiency of
  dopamine in their brains
• Looks like chlorpromazine and reserpine reduce
  brain dopamine levels
• Creating parkinsons like symptoms
• But alleviating symptoms of schizophrenia
• Thus - It was proposed that schizophrenia is
  associated with excessive activity in
  dopaminergic systems in the brain