Psychological Disorders: Part 2

1. Psychological Disorders: Part 2 Music: “She’s Hearing Voices” Block Party “Crazy” Gnarles Barkley

2. Today’s Agenda • 1. Schizophrenic Disorders • a) Symptoms • b) Movie: “The New State Asylums” (online) • http://www.pbs.org/wgbh/pages/frontline/shows/asylums/ • c) Theories • 2. Personality Disorders • a) Cluster A: • E.g. Paranoid • b) Cluster B: • E.g. Borderline, Antisocial • c) Cluster C: • E.g. Obsessive-Compulsive, Avoidant • 3. Quiz Questions • 4. Movie: Home Videos and Schizophrenia (6 min.)

3. Schizophrenic Disorders • Schizophrenia • “Split Mind” • Not a multiple personality disorder, but a thought disorder • 1. a) Symptoms: • 1. Disturbed Thought Content • Delusions: Grandiose or Persecutory • Expression is bizarre (e.g. loose associations/ poverty of speech) • 2. Hallucinations and Disturbed Behaviour • E.g. hearing voices/ speaking to imaginary people • Agitation or catatonic stupor http://www.youtube.com/watch?v=_qCcSQPh2Bc • 3. Disturbed Emotions • E.g. laughing inappropriately/ blunted, flat affect • 4. Deterioration in Functioning • E.g. Neglect of personal hygiene, social withdrawal

4. 1. b) Prisons: The New State Asylums • Frontline Show Available Online • Note: 2 multiple choice questions extracted from segment shown in class will be on the final) • http://www.pbs.org/wgbh/pages/frontline/shows/asylums/

5. 1. c) Theories of Schizophrenia • Genetic Contribution: (p. 635)

6. 1. c) Theories of Schizophrenia • Genetic Contribution: (p. 636) • But what is inherited? • Excess dopamine: • Evidence: • Drugs that increase dopamine produce symptoms similar to schizophrenia • Anti-psychotic drugs that decrease dopamine activity lessen schizophrenic symptoms • Epigenetics: • Study of chemical changes to a gene that influence its expression • (without altering DNA sequence) • 1/200 genes of psychotic patients show epigenetic differences • For genes involved in neurotransmission & brain development

7. 14.19, p. 636

8. 2. Personality Disorders • DSM-IV Definition: • Inflexible, enduring patterns of behavior that create impairment in functioning (especially conflict with others) and/or subjective distress • May involve up to 15% of population • Cluster A: Odd-Eccentric • Distrustful, socially aloof, unable to connect with others • schizoid, schizotypal, paranoid • Cluster B: Dramatic/Impulsive • Self-centered, (overdramatic), low impulse control • histrionic, narcissistic, anti-social, borderline • Cluster C: Anxious/Fearful • Maladaptive efforts to control anxiety • dependent, obsessive-compulsive, avoidant

9. 2. Personality Disorders: • A) Cluster A: Paranoid: (4%) • Suspects (without sufficient basis) that others are exploiting, harming, or deceiving him or her • Tends to be angry or hostile • Is preoccupied with unjustified doubts about the loyalty or trustworthiness of friends or associates • Perceives attacks on his or her character that are not apparent to others and is quick to react angrily • Has recurrent suspicions, without justification, regarding the fidelity of spouse or partner • Avoids confiding in others for fear of betrayal

10. 2. Personality disorders (cont’d) • 2. b) Cluster B: Borderline: (2%) • 20% of psychiatric patients • Frantic efforts to avoid real or imagined abandonment • A pattern of unstable and intense interpersonal relationships • Emotions spiral out of control, leading to extremes of anxiety, sadness, rage • Recurrent suicidal behavior, gestures or threats or self-mutilating behaviour • Identity disturbance, unstable self-image or sense of self • Impulsivity in at least 2 areas (e.g. spending, sex, substance abuse, reckless driving, binge eating)

11. 2. Personality Disorders (cont’d) • Antisocial: (3%) • Antisocial behaviors; violate the rights of others without shame or regret • i.e. Takes advantage of others; is out for number one • Superficial charm but deceitful, using lies to con others • Callous; no remorse • Irritable and aggressive, as indicated by repeated physical fights or assaults http://www.youtube.com/watch?v=B2fjkWIUjS8 • Onset before age 15 (conduct disorder) • Most promising cause: • Biological predisposition (limbic and frontal lobe abnormalities) Combined with neglect and abuse

12. 2. Personality Disorders (cont’d) • 2. c) Cluster C: Obsessive-compulsive: (8%) • Preoccupied with rules, details, organization, to the point where the major point of the activity is lost • Perfectionism that interferes with task completion • Excessively devoted to work and productivity to the exclusion of friendships or leisure activities • Show rigidity and stubbornness • Reluctant to delegate tasks or to work with others unless they submit exactly to his way of doing things

13. 2. c) Cluster C: (cont’d) • Avoidant Personality Disorder: (2%) • Avoids occupational activities that involve significant interpersonal contact, because of fears of criticism, disapproval, or rejection • Views the self as socially inept, inadequate, or inferior to others • Is preoccupied with being criticized or rejected in social situations • Fear of being shamed or ridiculed

14. 3. Review Quiz • For each case presented below, select a possible diagnosis according to the following choices: • A) Social anxiety D) Hypochondriasis • B) Obsessive Compulsive Disorder E) Somatoform Disorder • C) Generalized anxiety disorder F) Agoraphobia G) None of the above • Wesley has gone in for a psychiatric assessment. He tells the clinician the he has been feeling apprehensive and edgy for the last month, but so far his anxiety hasn’t interfered with his job or home life. • Doris feels terrified every time she leaves her house, and avoids doing so whenever possible. • Kate constantly thinks about jumping in front of an oncoming car when she is walking. The only way she seems to be able to stop these self-destructive thoughts is to say Mother Goose nursery rhymes over and over to herself. • Laura takes over 40 different vitamins and herbal remedies each day to keep herself in top physical health. Recently she had some severe dizziness, but her family doctor assured her that is was just a minor ear infection that would clear up in a few days. Laura is concerned because she is sure the ear infection is the sign of something much more serious, such as a brain tumor, and she has made appointments with three different specialists to have more testing done.

15. 3. Review Quiz (cont’d) • For each case, select the most appropriate personality style: • A) Avoidant B) Borderline • C) Paranoid D) Obsessive Compulsive • E) Antisocial • Sophia has always been preoccupied with schedules, lists, and trivial details. She plans everything sown to the last detail and becomes very upset if things don’t work out the way she has planned. • In the past 9 months Andrew has been fired by three different employers. He was unreliable and often missed work, and each employer finally let him go when they found he had been stealing money and materials. Andrew feels no remorse over his actions, but he has managed to convince each of his former employers that he is sorry for his actions, and none plan to press any charges. • Ellen is has been feeling both depressed and anxious. She would like to be in a relationship but feels that it is out of her reach. She becomes unbearably anxious in new social situations and does not see how she will ever be able to approach or speak coherently to someone of the opposite sex. • Roy alternates between periods in which he remains motionless and seems oblivious to his environment, and periods of hyperactivity and frenzied excitement. He seems to be responding to voices in his head.

16. 4. Movie (if the CD player will let me) • “Home Videos and Schizophrenia” • Can we learn to predict who will develop schizophrenia? In this video, students see how psychologists are using low-tech procedures like home videos, and high-tech procedures like hormonal measure and brain scans to better understand who might develop this very serious mental health disorder. • (6 min.)