Psychopathology or Psychological Disorders

1. Psychopathology or Psychological Disorders KING LEAR

2. Prevalence

3. Lifetime Rates by Gender

4. Diagnosis: A Necessary Step • Diagnosis • Process of identifying and grouping mental disorders with similar symptoms • DSM-IV American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (4th Edition)

5. Advances in diagnosis and therapy are success stories for clinical psychology/ psychiatry In 1955, 500,000 institutionalized for psychological disorders Today: 65,000 But mental hygiene arrests continue to this day (suicide, squalor, starving)

6. Major Affective Disorders “The mind is its own place, and of itself Can make a Heaven of Hell, a Hell of Heaven” - John Milton (Paradise Lost)

7. Major Affective Disorders

8. What is Bipolar disorder?

9. Mood cycles

10. Creativity & Bipolar

11. Creativity & Mood Dysfunction Iowa Writer’s Workshop, Andreasen, 1987 Other studies find 30x normal incidence rate in writers, musicians Why are they linked?

12. Hans Christian Anderson Ludwig von Beethoven Lord Byron Charles Dickens T. S. Eliot Ralph Waldo Emerson William Faukner F. Scott Fitzgerald Paul Gauguin Vincent van Gogh Ernest Hemingway Michelangelo Sylvia Plath Edgar Allan Poe Gordon Sumner (Sting) Peter Tchaikovsky Leo Tolstoy Mark Twain Virginia Woolf Tennessee Williams Famous Bipolar Artists • Creativity Connection • Emotional reactive (unfiltered life) • Disinhibited (loose associations) • Absorption (focus) • Intense creative episodes during hypomania

13. Vicious Cycle of Depression

14. Twenty-one dimensions of depression: 1. Sadness                              12. Social withdrawal 2. Pessimism                           13. Indecisiveness 3. Sense of failure                   14 Change in body image 4. Dissatisfaction                     15. Retardation 5. Guilt                                   16. Insomnia 6. Expectation of punishment    17. Fatigability 7. Dislike of self                       18. Loss of appetite 8. Self Accusation                    19. Loss of Weight 9. Suicidal ideation                   20. Somatic preoccupation 10. Episodes of crying              21. Low level of energy 11. Agitation In past week including today: 0 = I do not feel sad 1= I feel sad 2= I am sad all the time and I can’t snap out of it 3= I am so sad that I can’t stand it 0-63 max score (30+ indicates severe depression) Beck Depression Inventory (BDI) Aaron Beck

15. Treatment for Unipolar

16. Antidepressants

17. 30,000 Americans each year Nearly 2x the homicide rate 8th leading cause of death, 3rd for teens 2 x above the world rate - 16.7/100K Japan (1997) - 11.9/100K USA (1997) Females attempt 3x males, but males succeed 4x 60% successes with firearms Since 1950, suicide rates in teens has tripled Suicide Myth of Sisyphus (Camus): “There is only one really serious philosophical question, and that is suicide”

18. Suicide in Depression Cycle

19. Anxiety Disorders

20. Phobia Intense irrational fear of object or situation

23. Obsessive-Compulsive Disorder (OCD) • Obsessions: repetitive thoughts - germs, terrible events, symmetry & order • Compulsions: repetitive behaviors - grooming, rituals, checking locks, appliances

25. Dissociative Identity Disorder • Previously Multiple personality disorders (MPD)

26. Schizophrenia “Split Mind” Disorders involving gross distortions of thoughts and perceptions and by loss of contact with reality

27. Scz – the Disorder of Science and Math Isaac Newton – suffered psychotic break Albert Einstein – autistic traits, Scz son John Nash Jr – chronic schizophrenia Bertrand Russell James Joyce’s daughter Syd Barrett (of Pink Floyd) Socrates (perhaps, or temporal lobe epilepsy)

28. Paranoid: Delusions or hallucinations often include extreme suspiciousness and hostility Disorganized: Exhibit signs of illogical thinking and speech Catatonic: Exhibit extremes in motor behavior Undifferentiated: Do not clearly fit into a type Catatonia Types of Schizophrenia

29. Positive & Negative Symptoms • Positive Sx: cognitive, emotional, and behavioral excesses. • hallucinations, delusions, thought disorders, and bizarre behaviors. • Negative Sx: cognitive, emotional, and behavioral deficits. • apathy, flattened affect, social withdrawal, inattention, and slowed speech or no speech.

30. Schizophrenia rates • 1% across all cultures, despite few offspring • Male = females, or slightly more males • More in jails than psychiatric hospitals • 50% never accept that they are ill • 90% go off meds once+ (relapse within 3y) • Nearly 100% smoke (self-stimulation) • Higher prevalence in lower socioeconomic class • 25% full remission, 50% recurrent relapses (living independently on meds or less autonomously in group homes), 25% permanently hospitalized • 40% attempt suicide, 10% succeed

31. DSM-IV Criteria • Delusions • Hallucinations • Speech changes • Motor symptoms • Mood symptoms • Cognitive symptoms Must show 2 of following for 6 months

32. Delusions – incorrect conclusions about perceptions • Peculiar beliefs, culturally based aliens, secret lovers, paranoia, grandiosity, thought insertion or broadcast, erotomania • Ideas of reference events has special personal meaning • Magical thinking control events from afar

33. DSM-IV Criteria • Delusions • Hallucinations • Speech changes • Motor symptoms • Mood symptoms • Cognitive symptoms Must show 2 of following for 6 months

34. Hallucinations – inaccurate perceptions Most auditory; some visual, olfactory, tactile • Commanding voice of authority – God, historical figure, parent alive or dead • Derisive, insulting • Running commentary of life, feelings, thoughts

35. DSM-IV Criteria • Delusions • Hallucinations • Speech changes • Motor symptoms • Mood symptoms • Cognitive symptoms Must show 2 of following for 6 months

36. Speech changes • Mute vs pressured (“word salad”) • Insensitive to the informational needs of audience • Overall, a poverty of speech

37. DSM-IV Criteria • Delusions • Hallucinations • Speech changes • Motor symptoms • Mood symptoms • Cognitive symptoms Must show 2 of following for 6 months

38. Motor symptoms • Catatonia • Peculiar (e.g., strip naked to greet) • Bizarre gestures, grimaces • Stereotypies (rocking, flapping) • Violence to self, or family members

39. DSM-IV Criteria • Delusions • Hallucinations • Speech changes • Motor symptoms • Mood symptoms • Cognitive symptoms Must show 2 of following for 6 months

40. Mood symptoms • Blunted, inappropriate, or exaggerated • Flat affect, anhedonia, avolitional, vegetative • Suicidal

41. DSM-IV Criteria • Delusions • Hallucinations • Speech changes • Motor symptoms • Mood symptoms • Cognitive symptoms Must show 2 of following for 6 months

42. Cognitive Symptoms • Attention disorder • Loose associations (“knight’s move”) • Memory impairment • Executive functioning – serial, perseveration, monitoring

43. Knight’s Move

44. Impaired Theory of Mind • Failure to monitor • what different people can know • one’s own intentional actions • informational needs of others • one simply thought something • mental and physical distinctions

45. Course of Onset (Warning signs) • <7y: Failure to develop dominant hand early (55% autistics fail as well) • 8-12 y: interpersonal problems, poor emotional control, high IQ, sensitive • 12-16y: cognitive problems begin, underachievement, disorganized thoughts, poor emotional rapport, few friends • 17-20y: [prodomal or precursory] withdrawal, decreased grooming, altered school or work performance, delusions emerging, abuse hallucinogens like marijuana or LSD

46. Genetic Component Risk of developing schizophrenia in one’s lifetime increases as genetic relatedness with a diagnosed schizophrenic increases. Dopamine hypothesis