Abnormal Psychology

1. Abnormal Psychology Chap. 16, pg. 639

2. 4 Major Criteria • 4 major criteria for determining abnormal behavior • 1. Distorted perception • 2. Inappropriate behavior • 3. Causing discomfort to oneself or others • 4. Danger to oneself or others

3. Q: Where is the line between normal and abnormal? • Ex: peeing in public, funny, pooping in public, psychotic • Ex: Speaking in tongues in church? Feel the spirit? • Ex: Inappropriate behavior? Girls Gone Wild? Hazing? Drinking? Streaking at game?

4. Psychological Disorders in U.S. • Prevalence - frequency with which a given disorder occurs at a given time • Incidence - # of new cases of a disorder that arise during a given period • Neurosis - mental or emotional disorders, without organic cause (not biological), involving symptoms of anxiety and depression • Psychosis - severe mental disorder, with or without organic (bio) damage, characterized by derangement of personality and loss of contact with reality

5. Psychological Disorders in U.S. • NIMH- National Institute of Mental Health • Baker Act: (1973) 2 family members and 2 professional opinions (only FL) • GS122- Involuntary Commitment Form (72 hours) • friend/family and psychologist (children up to 2 weeks) • Meyers, 1984 - concluded that 1 out of 5 Americans suffer from some sort of psychological disorder • 29 million Americans of total population • 13 million - Anxiety Disorder • 10 million abuse drugs or alcohol • 1.4 million schizophrenics • 25,000 suicides - committed • 200,000 attempted suicides • Dohrend, 1986 - effects on family members and friends would increase the previous number

7. Family Cycle • Family and friends affected by the disorder (parents, children, spouses), it’s a FAMILY disease. • Like a pizza, each slice has a little on it, some slices have more than others

8. Classifying Abnormal Behavior • DSM-IV-TRDiagnostic and Statistical Manual for Mental Disorders - 4th ed (text revised) • Used to label homosexuality as “Abnormal” (1973) • The manual attempts to define illnesses specifically enough so that anyone trained in the field can diagnose the condition accurately and consistently • Smith and Kraft, 1983 - criticized manual for attempting to define all behavioral problems as diseases, when in fact they may only be “problems in living.”

9. Other Classifications: ICD & CCMD • DSM: www.psychiatryonline.com • ICD: International Classification • www.who.int/classifications/apps/icd/icd10online/?gf40.htm+f44 • CCMD-3: Chinese Classification • www.21jk.com/english/articlecontent.asp?articleId=27391

10. Historic View of Abnormality • Primitive Tribes - Madness was a sign that spirits possessed a person, yet possession could also be seen as sacred (schitzo) • Greeks (Hippocrates) - Madness is a natural event occurring from natural causes • Epilepsy - Brain melting into body resulting in fits and foaming at the mouth • Middle Ages - spiritual context of abnormal behavior – exorcisms (devil)

11. Historic View of Abnormality • Philippe Pinel, 1793 - director of Bicetre Hospital in Paris, 1st to remove mentally ill from chains - allowed them to move about the hospital grounds • Dorothea Dix, 1850’s- school teacher from Boston stopped horrors in U.S. Asylums (cages) which were turned into hospitals staffed by doctors, nurses, and attendants • Franz Anton Mesmer, 1890 - cured everything from Melancholy to Blindness through hypnosis • Fournier, 1894 - paresis - overall breakdown of the mind and body, common among 19th cent. merchants and soldiers (contracted through syphilis)

12. Current Views • 1. Psychoanalytic Model: disorders are repressed unresolved childhood traumas or unconscious internal conflicts (sexual urge) Freud, Erickson, Horney • 2. Behavioral Model: disorders are a learned reaction from the environment (ex: fear, depression, sexual behavior) • 3. Cognitive Model: Disorders are the result of internal processes like faulty thinking, and irrational beliefs. (Ex: belief that you have to be perfect) Beck, Ellis • Turk and Salovey, 1985 - self defeating beliefs lead to failure which then further strengthens the self- defeating beliefs • 4. Humanism Model: Somewhere along the way the individual did not process through the stages properly (trust vs. mistrust, safety issues, Maslow’s Hierarchy of needs) • 5. Biological Model: chemical or brain deformity causes dysfunction, use drugs, genetics, psychosurgery (lobotomy)

13. Category: Eating Disorders • ICD-10: F50 • Symptoms: to eat, or avoid eating, which negatively affects both one’s physical and mental health. They affect every part of the person’s life. Affect an estimated 5-7% of females in USA • Anorexia Nervosa: deliberate weight loss driven by distorted body image; intense fear of gaining weight and a preoccupation with body weight and shape; can stop the female menstrual cycle. Perfectionists with unattainable standards; low self-esteem, constant self-criticism; constantly fear losing control, even consuming a small amount of food considered a loss of control. Begins between the ages of 11-20. 3% end in suicid • Bulimia Nervosa: binge eating (overeating) followed by guilt, crash dieting, over-exercising/purging to compensate for calories. Physical high from binge, then numbing out, going into auto-pilot, losing all control, feeling famished and empty again, another uncontrollable binge; extreme eating and exercising habits (may accompany sexual promiscuity, pathological lying, and shoplifting). Ruins teeth enamel. • Binge Eating: consumes huge amounts of food during a brief period of time and feels totally out of control and unable to stop their eating. Can lead to serious health conditions such as morbid obesity, diabetes, hypertension, and cardiovascular (emotional eating). Obsessive Compulsive Overeating (OCO)

14. Category: Eating Disorders • ICD-10: F50 • Orthorexia Nervosa: obsession with eating only healthy types of foods; the drive to become pure, obsessed with everything you are consuming. • Selective Eating Disorder (SED) limited range of food, anxiety, social avoidance (could be Aspergers) • Pica: medical disorder characterized by an appetite for substances largely non-nutritive (clay, coal, soil, feces, chalk, paper, soap, mucus, ash, gum, glue, etc.) Named for a magpie bird which eats anything. Can be dangerous (eating lead paint, plaster, dirt contaminated with tetra-ethyl lead, gasoline, oil, toxic PCBs, dioxin, animal feces, parasites) Gender: all ages, pregnant women, small children, esp. developmentally disabled, animals, dogs

16. Category: Eating Disorders • Environmental Cause: media,the diet industry makes billions of dollars each year by consumers continually buying products in an effort to be the ideal weight. Hollywood displays an unrealistic standard of beauty that makes the public feel incredibly inadequate and dissatisfied, news reports unsafe food daily • Biological: severe OCD, depression, bulimia found to have low serotonin levels, Neurotransmitters such as serotonin, dopamine, norepinephrineare secreted by the intestines and central nervous system during digestion. Researchers have found low cholecystokinin in bulimics. Cholecystokinin is a hormone that causes one to feel full and decreases eating. Cortisolis a hormone released by the adrenal cortex which promotes blood sugar and increases metabolism. High levels of cortisol were found in people with eating disorders. • Many of these chemicals and hormones are associated with the hypothalamus in the brain. • 1. The genetic component (predisposition); • 2. The unique environmental factors, such as personal experiences; • 3) The shared environmental factors, such as culture. • Developmental: eating disorders stem from the adolescent’s difficulty in separating from over-controlling parents, and disturbed patterns of communication. When parents are critical and unaffectionate, their children are more prone to becoming self-destructive and self-critical, and have difficulty developing the skills to engage in self-care giving behaviors. • Trauma: many eating problems beginning as survival strategies (sexual abuse) rather than vanity or obsession with appearance.

17. Category: Tic Disorders • Labeled according to type (motor or phonic tics) and duration (transient or chronic). • 10 per 1000 children have tic disorders (eye blinking, coughing, throat clearing, sniffing, facial movements) • 1 of those 10 Tourette Syndrome (TS), Normal life expectancy and intelligence • Males are more likely than females to express tics (3 to 1) • ICD-10 F95.2TouretteSyndrome- TS (Gilles de la Tourettesyndrome, GTS)An inherited neuropsychiatric disorder, onset in childhood • Symptoms: multiple physical (motor) tics and at least one vocal (phonic) tic, often the exclamation of obscene words or socially inappropriate and derogatory remarks (coprolalia), repeating others (echolalia), repeating your words (palilalia), severity of the tics decreases after adolescence • Causes:Genetic, environmental causes, often comorbid conditions (co-occurring diagnoses suchas ADHD or OCD; Genetic studies show it may be inherited (50% chance of passing it on). Non-genetic, environmental, infectious, autoimmune, psychological, OCD; Biological: Tics are believed to result from dysfunction in cortical and subcortical regions, thalamus, basal ganglia, frontal cortex • Treatment: No 100% effective medication for every case of tics, but some medications and therapies can help. CBT (Cognitive Behavioral Therapy), relaxation, biofeedback, new experimental surgery (Australia) • Neuroleptics Drugs: Risperdal, Haldol, Prolixin, Stimulants, SSRIs (antidepressants) such as Prozac, Zoloft, Luvox

18. Category: Brain Development Disorders • Autism Spectrum Disorders (ASD) ASD is about 6 per 1,000 people, with 4 times as many boys as girls, diagnosis drastically up since 1980s • Autism: brain development issues with impaired social interaction and communication and restricted and repetitive behavior. • Symptoms: begin before a child is 3 years old. Affects many parts on brain, have difficulty with imaginative play, developing symbols into language, making friends, may seem “locked in”, compulsive behavior, arranging objects in a certain way (sameness), resistance to change (insisting furniture not be moved) or refusing to be interrupted. Ritualistic behavior: the same way every time (1 food, daily habits, 1 TV show, 1 toy) restricted focus or interest, preoccupation with 1 thing, 30% self-injury (crash helmets) • Aspergers: ICD-10 F84.0 High functioning, high IQ, milder signs and symptoms (taste, lights, sound) make excellent mathematicians, computer technicians, not usually good with social situation (Autistic Savants, Ex: Rain Man) • Causes: Strong genetic basis, mutation (birth defect), childhood vaccines, chemicals in environment, food, water, Mirror neurons? Precise line of toys

19. Category:Anxiety Disorders • Different forms of abnormal and pathological fears and anxieties • Gender/Culture: more often in women • A. Generalized Anxiety Disorder • B. Panic Disorder • C. Phobic Disorder (phobias, social, specific) 500+ accepted phobias • Ex: Agoraphobia: fear of being alone, or open spaces • Lalophobia: fear of public speaking Nomophobia: fear of being without mobile phone contact • Ophidophobia: fear of snakes Epistemaphobia: fear of schools • Kinesophobia: fear of movement Gephyrophobia: fear of bridges • Roundaphobia: fear of circular rides Acrophobia: fear of heights • Xenophobia: fear of strangers Anemophobia: fear of high winds • Mysophobia: fear of dirt and germs (TV: Monk) • D. Social Anxiety Disorder (fear of public speaking, fear of being around other people • E. Obsessive-Compulsive Disorder (OCD) Body Dysmorphia Disorder (BDD) • F: Post-Traumatic Stress Disorder (PTSD) • G. Separation Anxiety • Treatment: lifestyle changes, psychotherapy, cognitive behavioral therapy • Pharmaceutical medications: Benzodiazepines, “bennies”; Alprazolam (Xanax); Diazepam (Valium); Antidepressants (SSRIs, Serotonin-Specific Reuptake Inhibitor) paroxetine (Paxil), venlafaxine (Effexor); GABA analogues (NT in CNS, gabapentin, pregabalin); TCAs (Tricyclic antidepressants, imipramine); MAOIs (Monoamine oxidase inhibitors); Atypical antipsychotic (quetiapine, piperazines, hydroxyzine) • Alternatives: Reducing caffeine, regular aerobic exercise and improving sleep (melotonin).

21. Category: Conversion Disorders • Condition where patients have neurological symptoms such as numbness, paralysis, or fits (hysteria) also impaired hearing, vision, loss of sensation, impaired speech, gait. • Neurologist Jean-Martin Charcot, Psychiatrists: Pierre Janet, and Sigmund Freud • A. Factitious Disorder (Malingering) • Münchausen Syndrome (also by Proxy MSbP/MSP) • B. Somatization Disorder (Stress, Hypochondria) • C. Hysterical Paralysis/Motor Conversion Disorders • D. Hysterical Aphonia(loss of speech) • E. Psychogenic (Non-Epileptic Seizures) • F. Fixed Dystonia(neurological, may be inherited, birth-related, physical trauma, infection, poisoning, drug related) • G. Tremor, Myoclonus(muscle twitch), or Movement Disorders • H. Gait Problems (Astasia-Abasia) inability to stand or walk • I. Sexual Dysfunction (See Psychosexual) • Age/Gender: may present at any age, rare in children younger than 10 years, rare in the elderly. Studies suggest a peak in mid-to-late 30s • Treatment: Perceived as a psychological cause by many. Can you attribute physical symptoms to a psychological cause? Is the condition genuine (faking it, hypochondriac, attention)? Common, potentially reversible, follow up neurologically, Physiotherapy where appropriate; Treat depression or anxiety (if present), Cognitive behavioral therapy, hypnosis, EMDR (Eye Movement Desensitization & Reprocessing), psychodynamic/psychotherapy, abuse/trauma • Freud would say hysterectomy or psychosurgery for hysterics, anxiety

23. Category: Dissociative Disorders • Conditions that involve disruptions or breakdowns of memory, awareness, identity and/or perception. Some aspect of the personality seems fragmented from the rest. • 4 dissociative disorders listed in DSM IV TR: • A. Depersonalization Disorder(DSM Code 300.6) - periods of detachment from self or surrounding which may be experienced as "unreal" (lacking in control of or "outside of" self) while retaining awareness that this is only a feeling and not a reality. Person feels unreal and unconnected to his/her own body. • B. Dissociative Amnesia(DSM 300.12) (formerly Psychogenic Amnesia) - noticeable impairment of recall resulting from emotional trauma • C. Dissociative Fugue(DSM 300.13) (formerly Psychogenic Fugue) - physical desertion of familiar surroundings and experience of impaired recall of the past. This may lead to confusion about actual identity and the assumption of a new identity. Leave home, end up in strange city--don’t know how you got there. • D. Dissociative Identity Disorder(DSM 300.14) (formerly Multiple Personality Disorder) - the alternation of two or more distinct personality states with impaired recall, among personality states, of important information. • True split personality/multiples are quite rare (Sybil, Eve, When Rabbit Howls, Trudi Chase) • Treatment: Very controversial! EMDR, Hypnosis, Re-integrate personalities, memories made-up or real? Often cases of severe abuse, ritual abuse, animal/satanic abuse/cults. In a 2007 study, only 28.7% of the dissociative participants had received psychiatric treatment previously, often misdiagnosed bi-polar, ADD/ADHD.

25. Category: Affective/Mood Disorder • Person’s emotional mood is an underlying issue. (English psychiatrist Henry Maudsley) • 2 groups of mood disorders: (also could be drug, alcohol induced) • Mania: Overly excited, euphoric • Hypomanic: Depression • Major Depressive Disorder (Unipolar depression) • Atypical Depression: mood reactivity (paradoxical anhedonia) comfort eating, excessive sleep, or somnolence (hypersomnia) • Melancholic Depression: loss of pleasure (anhedonia) usually depressed in the mornings (psychomotor retardation), weight loss, excessive guilt • Psychotic Depression: major depressive episode, delusions, hallucinations • Catatonic Depression: rare, severe, disturbances of motor behavior and other symptoms. • Postpartum Depression: intense, sustained, disabling depression experienced by women after giving birth. 10-15%, set sin within 3 months of labor, can last 3+ months.

27. Category: Affective/Mood Disorder • Seasonal Affective Disorder: seasonal pattern, autumn or winter, usually resolved in Spring, Northern states, countries more affected by this. (Vitamin deficiency?) • Dysthymia: chronic, milder mood disturbance, low mood almost daily over a span of at least two years. • Recurrent Brief Depression (RBD) duration (once a month? 2 days- less than 2 weeks) ex: menstrual cycle • Bipolar Disorder (Manic Depressive) alternating mania and depression, rapid cycling, mixed states, psychotic symptoms, Bipolar I & II, Cyclothymia (mild) • Psychoanalytic: relationships (lover, child) real or imagined loss • Behavior: deficiency in social skills, lack of reinforcement, low self-esteem • Cognitive: learned as a thought process during stress, illogical thinking, conclusion without evidence, magnification and minimization • Biological: depression is genetic (family cycle) withdraw from alcohol, drugs, treat with Benzodiazapines(bennies), increase serotonin and norepinephrine • Humanism: Depression and creativity? Blues, artists (Picasso), Actors

29. Category: Psychosexual Disorders • Freudian Psychology, oral or anal fixation (mother of father, potty training); Alfred Kinsey (Movie) 1948, most Americans enjoy sexual activities forbidden by laws • 2 Types: • 1. Sexual Dysfunction: inability to function effectively during sex, impotence (ED, men) Frigidity for women (sexual dissatisfaction) • Inhibited Sexual Desire: lack of interest, fear, cannot achieve or sustain arousal • Hypoactive sexual disorder, asexuality, Sexual Aversion Disorder (avoid sex) • Female/Male Orgasmic Disorder (Anorgasmia), Premature Ejaculation • Dyspareunia: Sexual pain disorders (painful intercourse) • Vaginismus: an involuntary spasm of vaginal wall muscles that interferes with intercourse. • PTSD: due to incest, rape, childhood trauma, genital mutilation • Transsexual/Transgender issues (before surgery)

30. Category: Psychosexual Disorders • 2 Types: • 2. Paraphilias: the use of unconventional sex objects or situations for arousal (stimulation) • Fetishisms: reliance on non-human objects for sexual excitement (bicycle seat, shoe) • Voyerism: watching others have sex, spying on nude people • Exhibitionism: compulsion to expose one’s genital in public, to achieve arousal • Transvestism: wearing clothes of opposite sex (cross dressing, Eddie Izzard) • Sadomasochism: aggression, inflict pain, bondage (S&M) • Pedophilia:desire to have sexual relations with children • Beastiality: arousal with animals (I Love Ewe) • Necrophilia: aroused by sex with dead people • Olfactophilia: sexual arousal by scents and odors enamoring from the body. Especially sexual locations. • Treatment: Sexual Dysfunction (Frigidity, Libido, ED, prescribe SSRIs, Sildenafil/Viagra) May be hormonal changes caused by menopause, pregnancy, breast-feeding, poor lubrication • Is dysfunction emotional or physical (sexual fears or guilt, past sexual trauma, sexual disorders) Sexual activity may be impacted by physical factors (enlarged prostate, blood supply, nerve damage, spinal cord injuries, birth defects), drugs (alcohol, nicotine, narcotics, stimulants, antihypertensives, antihistamines, psychotherapeutic drugs), disease (MS, tumors, diabetes), hormonal deficiencies (low testosterone, estrogen, androgens) • Paraphilias may require cognitive, behavioral therapy, psychosurgery

31. Darth Vadar Fetish

32. Category: Personality Disorder • Mental & Behavioral Disorders, Adult Personality & Behavior (Character Disorders) ICD-10 (F60-F69) • Range from harmless to cold-blooded killers, maladaptive way of thinking (TV: Dexter, Metacafe) These behavioral patterns often cause serious personal and social difficulties, or general functional impairment. • APA: “an enduring pattern of inner experience and behavior that deviates markedly from the expectations of the culture of the individual who exhibits it” • The behavior is ego-syntonic (consistent with the ego-integrity of the individual), perceived as appropriate by that individual. A ruthless businessmen (successful) psychopath (unsuccessful) • Onset typically late adolescence and beginning of adulthood (rare childhood). • 1. Schizoid Personality Disorder: lack of warm feelings towards others, unable to form bonds, lack of interest in social relationships, seeing no point in sharing time with others, SchizotypalPersonality Disorder: avoids social relationships, out of a fear of people • 2. Paranoid Personality Disorder: suspicious, mistrustful, refuse criticism, secretive, devious, scheming, argumentative, irrational suspicions (they’re coming to take me away! Just because you’re paranoid doesn’t mean they’re NOT out to get you!) • 3. Narcissistic Personality Disorder: total self-absorption, grandiose sense of self, preoccupation with success fantasies, need for constant attention, admiration, inability to love or care for others (lack of empathy). “God Complex”

33. Category: Personality Disorder • 4. Antisocial Personality Disorder: do not socialize with others (hermit, Grumpy Old Men) cannot be diagnosed for people under 18. Pervasive disregard for the law and rights of others. (Ted Kaczynski, The Unibomber) • 5. Borderline Personality Disorder: extreme “black and white” thinking, instability in relationships, self-image, identity and behavior (I Hate You, Don’t Leave Me). • 6. Histrionic Personality Disorder: pervasive attention-seeking behavior including inappropriate sexual seductiveness and shallow or exaggerated emotions, including superficial charm, insincerity, egocentricity and manipulation. • 7. Avoidant Personality Disorder: social inhibition, feelings of inadequacy, extreme sensitivity to negative evaluation, avoidance of social interaction • 8. Dependent Personality Disorder: pervasive psychological dependence on other people (co-dependence, people pleasing) • Symptoms: problems with the perception and interpretation of self, others and events, inappropriate emotional response or affect, interpersonal functioning, impulse control, child abuse and neglect may be the cause • Cognitive: Rigid and on-going patterns of feeling, thinking, and behavior are caused by an underlying belief system (fixed fantasies or schemata)

35. Category: Schizophrenic Disorders • Schismmeans “split”,mental disorder characterized by abnormalities in the perception or expression of reality. (Fight Club, A Beautiful Mind, John Nash, Secret Window, The Shining) • Hallucinations - false sensory perceptions • Delusions - false beliefs about reality with no factual basis • Symptoms: auditory hallucinations, paranoid, bizarre delusions, disorganized speech, thinking, may range from loss of train of thought and subject flow (sentences only loosely connected in meaning), to incoherence, such as “what is a salad?” Grossly disorganized behavior (dressing inappropriately, crying frequently), social isolation, avolition (apathy or lack of motivation), may even be mute, motionless, bizarre postures, catatonia, agitation, irritability and dysphoria (lack of pleasure). • Under stress or in confusing situations, include excessive attention to potential threats, jumping to conclusions, making external attributions, impaired reasoning about social situations, altered mental state, distinguishing inner speech from speech from an external source, difficulties with early visual processing and maintaining concentration. 5% to 10% of those charged with murder in Western countries have a schizophrenic disorder. More often (14x) they are the victim of violent crime (rape, beating) than the perpetrators • Psychiatrist Kurt Schneider (1887-1967) “Schneider’s First-Rank Symptoms”Delusions of being controlled by an external force (A Beautiful Mind, Fight Club), Belief that thoughts are being inserted into or withdrawn from one’s conscious mind, Belief that one’s thoughts are being broadcast to other people (outside your head), Hearing hallucinatory voices that comment on one's thoughts or actions or that have a conversation with other hallucinated voices. • Positive Symptoms: things most individuals do not normally experience (delusions, hallucinations, auditory, thoughts) • Negative Symptoms: Loss or absence of normal traits or abilities, flat emotions (affect) lack of speech (alogia), lack of pleasure (anhedonia), lack of motivation (avolition) • Positive & Negative Syndrome Scale (PANSS) manage symptoms, but no cure • Age/Gender: Typical onset is late adolescence to early adulthood. Some recreational and prescription drugs appear to cause or worsen symptoms. Occurs equally in males and females, earlier onset in men (20–28 years) 26–32 years for females.

37. Category: Schizophrenic Disorders • Subtypes: (5) DSM 295.1-9, ICDF20.0-F20.5 • Paranoid Type: Delusions and hallucinations are present but thought disorder, disorganized behavior, and affective flattening are absent. • Disorganized Type: Named hebephrenic schizophrenia in the ICD. Where thought disorder and flat affect are present together.Giggling, grimacing, frantic gestures, childish disregard for social conventions. Ex. May urinate or defecate at inappropriate times. They are active but aimless, incoherent conversations. • Catatonic Type: The subject may be almost immobile or exhibit agitated, purposeless movement. Symptoms can include catatonic stupor. • Undifferentiated Type:Psychotic symptoms are present but the criteria for paranoid, disorganized, or catatonic types have not been met. • Residual Type: Where positive symptoms are present at a low intensity only.

38. Category: Schizophrenic Disorders • Biological School: suggests genetics (twin studies), early environment (prenatal exposure to infections in utero?), neurobiology, increased dopamine activity in the mesolimbic pathway of the brain. Born in winter or spring? FMRI, brain imaging, Glutamate NT may hold the key, glutamate blocking drugs (phencyclidine, ketamine) mimic the symptoms and cognitive problems associated with the condition. • Humanism: psychological and social stressors (job, environment, home) Social disadvantage, racial discrimination, family dysfunction, social adversity, poverty, unemployment or poor housing conditions, childhood abuse or trauma. Psychiatrist Thomas Szasz argued that psychiatric patients are not ill, but are individuals with unconventional thoughts and behavior that make society uncomfortable.Society unjustly seeks to control them by classifying their behavior as an illness and forcibly treating them as a method of social control. • Cognition: mainly affects thinking (but also behavior and emotion) neurocognitive deficits in memory, attention, problem-solving, executive function, social cognition • Julian Jaynes, 1976, The Origin of Consciousness in the Breakdown of the Bicameral Mind, until the beginning of historic times, schizophrenia (or a similar condition) was the normal state of human consciousness. The “bicameral mind” would hear “mysterious voices in the bible and ancient texts, burning bushes talking to you, giving instructions, which early people characterized as interventions from the gods. • Paul Kurtz, major religious figures experienced psychosis, heard voices and displayed delusions of grandeur.

39. Category: Schizophrenic Disorders • Culture: Varies across the world,within countries,and between urban and country lifestyle (drug use, ethnic group, social group) 3rd most-disabling condition in 14 countries (1999). Social problems: unemployment, homelessness, lower life expectancy, high suicide rate. In non-Western societies, schizophrenia treated with more informal, community-led methods. US, Australia laws allow forced drugs on those who refuse but are otherwise stable and living in the community. WHO: people diagnosed in non-Western, developing countries (India, Columbia, Nigeria) do better than developed (US, UK, Ireland, Denmark, Czech, Slovakia, Japan, Russia),despite antipsychotic drugs not being widely available. Better social connectedness and acceptance. • Researchers into Shamanism, schizophrenia;the experience of having access to multiple realities, altered states of consciousness, psychiatrists label as illness. (N. American, MesoAmerican, Africa, VooDoo, Santeria) • 20th Century: Considered to be a hereditary defect, eugenics, hundreds of thousands sterilized, Nazi Action T4 program, USA, Scandanavian. USSR, diagnosis used for political purposes, Andrei Snezhnevsky created sub-class “sluggishly progressing schizophrenia” (1977 condemned by World Psychiatrists) • 2002, Japanese Society of Psychiatry & Neurobiology changed term from Seishin-Bunretsu-Byo　精神分裂病 (mind-split-disease) to Tōgō-shitchō-shō　統合失調症 (integration disorder) using a bio-psychosocial model • Treatment: antipsychotic medication (chlorpromazine, 1950s), suppresses dopamine activity, drugs (Risperdal/Risperidone, Clozapine) can reduce positive symptoms, drugs fail with the negative symptoms, drugs also have lethal side effects. Likely to have other symptoms (depression, anxiety, substance abuse 40%, weight gain). Involuntary hospitalization, electroconvulsive therapy, psychosurgery. • Psychotherapy, cognitive behavioral therapy (CBT), vocational and social rehabilitation used to target specific symptoms and improve self-esteem and social functioning. Family therapy also helpful. • Alternative Treatment: Music and creative therapies. Treated with megadoses of nutrients,vitamin B-3 (Niacin), possible allergic reaction to gluten (flour). Self-help groups: Hearing Voices Network, Paranoia Network

40. Q: What if they’re right and we can’t see what they see? Dogs and cats sense more than we do.

41. Strange Disorders • Charles Bonnet (Bon-et) Syndrome (CBS): visually impaired people experience lucid hallucinations. • a condition that causes patients with visual loss to have complex visual hallucinations, 1stintrod. into English-speaking Psychiatry in 1982. • Hallucinations in which the characters or objects are smaller than normal. 10% - 40% people have them, Australian 17.5%, Asia much lower. • Sufferers: predominantly female • No treatment of proven effectiveness for CBS • Ramachandran’s book/video: Phantoms in the Brain, Oliver Sacks: • www.ted.com/talks/oliver_sacks_what_hallucination_reveals_about_our_minds.html

42. Strange Disorders • Phantom Limb Syndrome: pain in missing limb • The sensation that an amputated (or missing) limb (or organ, appendix) is still attached • Approximately 50- 80% of individuals with an amputation experience phantom sensations in their amputated limb, and the majority of the sensations are painful. • Feel: warmth, cold, itching, squeezing, tightness, tingling • Causes: made worse by weather, stress, anxiety, cell memory • (phantom tooth pain, phantom eye syndrome) • Ramachandran, 1998; Tim Pons, 1990 • Treatment: use of visual feedback as treatment (the mirror box), drugs (antidepressants), spinal cord stimulation (SCS), vibration therapy, acupuncture, hypnosis, biofeedback

43. Strange Disorders • Capgras Delusion (Capgras Syndrome) a disorder in which a person holds a delusional belief that a friend, spouse or other family member has been replaced by an identical-looking imposter. • Can occur with schizo, brain injury, dementia • May not recognize themselves, their pets • Category: Delusional Misidentification Syndrome • Blount (1986) case, patient decapitated his father looking for batteries in the “robot’s” head). • Face recognition and emotional centers in amygdala are severed, used galvanic skin response (GSR) to measure emotional arousal • Ramachandran’s book/video: Phantoms in the Brain, Invasion of the Body Snatchers • Drug: diazepam

44. Strange Disorders • Cotard’s Delusion(Cotard Syndrome) the patient believes they are dead, do not exist, in hell. • Rare neuropsychiatric disorder (depression and derealization) • Young and Leafhead(1996) describe a modern-day case of Cotard delusion in a patient who suffered brain injury after a motorcycle accident • Causes: Brain areas of recognition (amygdala and other limbic structures). Serotonin (antidepressant) drugs do not have any effect

45. Strange Disorders • Anosognosia: the patient denies a deficit • Their left hand is paralyzed but the patient may insist their arm is just tired or that they don’t wish to move the arm. • May stop taking drugs, deny they have a problem