Psychological disorders

1. Psychological disorders FEM 4100 Brain and human behaviour

2. Outline • Psychological disorders • Mood disorders • Somatoform disorders • Anxiety disorders

3. Psychological Disorder (1/4) • Refers to psychological or physiological pattern that is usually associated with distress or disability that is not expected as part of normal development of culture. • Dysfunction in psychological disorders are assumed to be the product of disruptions of thought, feelings, communication perception and motivation. • Not every dysfunction leads to a disorder, only those that result in significant harm.

4. Psychological Disorder (2/4) • There is no single accepted or consistent cause of psychological disorders. • Over one third of people in most countries reporting sufficient criteria at some point in their life. • How do we diagnosis with mental health: • Using different methodologies – case history and interview • How we treat mental patient? • Psychotheraphy and psychiatric medication, supportive interventions • Treatment may be volunteer or involuntary when it is required by law • Widespread problems with stigma and discrimination

5. Psychological Disorder (3/4) • Jerome Wakefield propose the idea of mental disorder as ‘harmful dysfunction’, meets tow criteria: • The condition causes harm according to social values of a persons culture (suffering, unable to work) and; • The condition results from and underlying mechanism that fails to perform according to its natural fuctnion. • Characteristics include: • Present distress (painful symptoms) • Disability (impairment in important areas of functioning); and • Significantly increased risk of suffering pain, death, disability or loss of freedom.

6. Psychological Disorder (4/4) • Insanity – a legal term that refers to judgement about whether a person should be held responsible for criminal behaviour if he/she is mentally disturbed. • Define abnormal behaviour in terms of statistical norms – how common or rare it is in general population • Prevalance of psychological disorder: • Major depression 5% • Bipolar 1.2% • Schizophrenia 1.1% • Panic disorder 1.7% • OCD 2.3% • Generalised anxiety disorder 2.8% • Social phobia 3.7% • Agoraphobia 2.2% • Specific phobia 4.4%

7. MOOD DISORDERS • Is a condition whereby the prevailing emotional mood is distorted or inappropriate to the circumstances. • Characterised by extreme and unwarranted disturbances in emotion or mood • Two major types of mood disorder: Depression (or unipolar depression) and Bipolar disorder • Depression - marked by feelings of great sadness, despair and hopelessness as well as the loss of the ability or experience pleasure. • Types of Depression: • Major depression • Major depression (recurrent) • Major depression with psychotic symptoms (psychotic depression) • Dythymia • Postpartum depression

8. Bipolar disorder – a mood disorder formerly known as ‘manic depression’ and described by alternating periods of mania and depression • Subtypes include: • Bipolar I • Bipolar II • Cyclothymia • Rate of depression: • Twice as likely among female compared to male • Reasons: Conflicting roles of wife, lover and friend • Boys – twice as likely before puberty, Female – twice as likely after puberty • More severe consequences among women.

9. Major Depressive Disorder - Symtpoms • Changes in appetite, weight or sleep pattern • Loss of energy • Difficulty in thinking or concentrating • Psychomotor disturbance • Slowed body movements, reaction time and speech or • Constant movement, fidgeting, wringing of hands and pacing • Psychotic depression when severe • Delusions or hallucinations • Major depressive disorder lasts 1 year after initial diagnosis. • Generally, about 40% of patients are without symptoms, 40% are still suffering with the disorder • 20% are still depressed but not enough to warrant hospitalisation. • Less than half of hospitalised patients are fully recovered.

10. Major Depressive Disorder - Treatments • Many receive antidepressant drugs. • Studies reflect psychotheraphy is equally effective. • 50% - 60% have recurrence; recurrence greatest for females and when initial onset is before 15. • 20% - 35% of patients recurrence is chronic-lasting more than 2 years. • What are preventive measures? • Medication, Psychotheraphy • Social support & Exercise • Medications: • Selective serotonin reuptake inhibitors (SSRIs) • Tricyclics (TCAs) • Monoamine oxidase inhibitors (MAO-Is) • Most recently developed drugs

11. Bipolar Disorder • Manic episodes alternate with periods of depression usually with relatively normal periods in between. • Manic episode: • Excessive euphoria • Inflated self esteem • Wild optimism • Hyperactivity • Temporarily lose touch with reality • Frequently have delusions of grandeur along with euphoric highs • May waste large sums of money on get-rich schemes • Likely become irritable, hostile, enraged or dangerous if stopped • May be hospitalised to protect themselves from disastraous consequences

12. Bipolar disorder - Prevalance • Affect 1.2% of the population • Equal prevalance among male and female • More than 90% have recurrences • 50% have within a year recovery rate • 70% to 80% return to a state of emotional stability Effects: • Mild cognitive deficits following manic episodes • Many manage disorders and live normal life with the aid of medication. • Psychotheraphy helps to cope with stress of chronic mental illness.

13. Causes of Mood Disorders 1) Biological factors • Heredity and abnormal brain structure ad chemistry • Abnormal levels of serotonin linked to depression and suicide; • Production, transport and reuptake patterns of dopamine, GABA and norepinephrine different than normal people; • Neurotransmitter abnormalities may reflect genetic variations. • Heritability of depressive disorder – 70%; followed by 30% environment; • 50% of identical twins & 7% of fraternal twins • Biological relatives of bipolar disorder sufferers, tend to report higher risk of other mental disorder

14. Depression can be caused by a lack of the neurotranmitter serotonin in the brain. Mnny people are taking SSRIs such as Prozac or Zoloft. The other reason for depression caused by a chemical imbalance is it’s caused by a lack of the dopamine in the brain.The type of depressive-feeling caused by a lack of dopamine in the brain is a very low energy depression, with a complete lack of motivation, (and feeling depressed). You may feel frustrated that you don't have any energy. 

15. Causes of Mood Disorders 2) Cognitive factors • Depressive individuals view themselves, the world, and future in a negative way. • Interactions are seen as a series of burdens and obtacles that end in failure. • How they think? • ‘Everything turns our wrong.’ • ‘I never win’ or ‘it’s no use’ • ‘Things will never get better’

16. Causes of Mood Disorders 3) Life stressors • Vast majority of depression occurs after major life stress. • Women more likely to experience a severe negative life events just prior to onset of depression. • However, people with biological predisposition is different (recurrences without major negative live events/stressors) • Mood disorders is major risk for suicidal in all age groups, especially when exposed to life stressors. • Suicidal behaviour runs in families. • More likely among women than men; older people are at greater risk than younger.

17. SOMATOFORM DISORDERS • Also known as Briquet’s syndrome • Charaterised by physical symptoms that mimic disease or injury for which there is no identifiably physical cause or physical symptoms such as pain, nausea, depression and dizziness. • Physical symptoms present due to psychological causes rather than any known medical condition. • People with somatoform disorders – not faking illness to avoid work or other activities. • No general medical condition, other mental disorder or substance is adequately diagnosed. • Complaints are serious enough to cause – significant emotional distress, impairment of social and occupational functioning. • Implied psychological disorders, not the result of conscious malingering or factitious disorders.

18. 1) Hypochondriasis • Persons are preoccupied with their health and fear that their physical symptoms are a sign of some serious disease despite of reassurance from doctors; • Not convinced when medical examination reveals no problem. • Symptoms are not consistent with known physical disorders; • May ‘doctor shop’ seeking confirmation of their worst fear • Not easily treated with a poor chance of recovery.

19. 2) Conversion Disorder • A person suffers a loss of motor or sensory functioning in some part of the body. • The loss has no physical cause but solves some psychological problem. • May become blind, deaf, unable to speak or paralysis in some part of the body. • Sigmund Freud believes that it is an unconscious process to help solve an unconscious sexual or aggressive conflict.

20. 3) Dissociative Disorder • Disorders which, under unbearable stress, consciousness becomes dissociated from a person’s identity or his/her memories of important personal events or both. a) Dissociative Amnesia • A complete or partial loss of the ability to recall personal information or identity past experiences which cannot be attributed to forgetfulness or substance abuse. • Cause: traumatic experience or a situation creating unbearable anxiety causing the person to escape by ‘forgetting’ • However, they do not forget how to carry out routine task and basic personality remain intact.

21. b) Dissociative fugue • A complete loss of memory of one’s entire identity • May assume a new identity that is more outgoing and uninhibited than their former identity. • Usually a reaction to a severe psychological stress. • May last hours or months and may have no memory of initiating stressors or events during the episode.

22. c) Dissociative Identity Disorder (DID) • Two or more distinct, unique personalities occur in the same person; • Severe memory disruption concerning personal information about the other personalities. • 50% of cases there are more than 10 personalities. • Usually, change occurs during sudden and during stress; host personality is one in charge of body most of the time. Alter personalities: • Radical difference in intelligence, speech, accent, vocabulary, posture, body language, manners, had writing and sexual orientation etc. • 80% host personality doesn’t know alter personality BUT alter personalities have varying levels of awareness of each other. • Lost time: Periods with no memory when in alter personality.

23. ANXIETY DISORDERS (AD) • AD all have unrealistic, irrational fears or anxieties of disabling intensity; frequent fearful thoughts aobut what might happen in the future. • Comprised of several different forms of abnormal, pathological anxiety, fears, phobias. • It describes nervous system disorders as irrational or illogical worry not based on fact. • Based on Diagnostic and Statistical Manual of mental Disorders (DSM-IV-TR), • Phobia = persistent or irrational fear • Fear = an emotional and physiological response to a recognised external threat.

24. ANXIETY DISORDERS • Anxiety is an unpleasant emotional state. • Often accompanied by physiological symptoms such as fatigue or exhaustion. • Crucial to distinguish different anxiety disorders – accurate diagnosis is more likely to result in effective treatment and a better prognosis. • Types of Anxiety Disorder: • Generalised anxiety disorder • Panic attacks • Phobias • Obsessive-Compulsive Disorder (OCD)

25. Generalised Anxiety Disorder • Plagued with chronic worry for 6 months or more • Causes: Problems with finances, health, work or ability to function socially • Affects twice as many women as men. • Treatment: Antidepressant drugs and cognitive and behavioral therapies • Symptoms: • Feeling tense, tired and irritable • Trembling, palpitations, sweating, dizziness, nausea and diarrhea

26. Panic Attacks • An episode of overwhelming anxiety, fear or terror. • 2% of men and 5% of women in US. • Treatment: Medication and psychotheraphy • Symptoms: • A pounding heart • Uncontrollable trembling or shaking • Sensations of choking or smothering • Feeling as if you are going to die • Feeling as if you are going crazy • The more catastrophic the belief, the more intense the panic • Reccuring panic attack may be diagnosed with panic disorder • Increased risk for abuse or alcohol and other drugs

27. Phobias • Phobia • An irrational, intense, persistent fear of certain situations, activities, things or persons. • Symptom: • Excessive, unreasonable desire to avoid the feared subject • Fear is beyond one’s control; interfering with one’s life • Life is planned around avoiding feared situations – may not leave home unless accompanied by a frined, family member or when severe, not even then. • Affects physical, psychological, social, occupational and interpersonal and economic areas of life. • Gender differences: Women 4 x more likely • Begins typically in early adult years with panic attacks.

28. Types of Phobia Social phobia: • An irrational fear and avoidance of any social or performance situation in which one might embarrass or humiliate oneself in front of others by shaking, blushing. Sweating or appearing clumsy, foolish or incompetent. • Performance anxiety: Speaking in public, Performance at work, education or social life, • Turn to alcohol or tranquilizers to reduce symptom’s affect. Specific phobia (ranked by frequency of occurrence): • Situational phobias (elevators, airplanes, enclosed places, tunnels) • Fear of natural environment (storms or water) • Animal phobias (dogs, snakes, mice etc.) • Blood injection-injury phobia (fear of seeing blood or receiving injection) • Claustrophobia (closed spaces) and acrophobia (heights) most often treated or a panic attack.

29. Causes of phobias • Combinations of external events and internal predispositions. • Can be traced back to specific triggering event (ie traumatic experience at an early age) • Heredity • Heredity, genetics and brain chemistry combine with life experiences play a major role in the development of anxiety disorders and phobias. • May be caused by direct conditioning, modeling or the transmission of information or traumatic childhood experience with feared object (ie dog) or situation (ie drowning in a swimming pool) • Treatment: • Classical conditioning: Help patients associate pleasant emotions with feared items. • Behaviour modifications: patients are reinforced for exposing themselves to fearful stimuli • Modelling: Observing people who do not fear to the situation of object

30. Obsessive-Compulsive Disorder (OCD) • Characterised by a subject’s obsessive, distressing, intrusive thoughts and related compulsions (tasks or rituals) which attempt to neutralise the obsessions. • A person suffers from recurrent obsession or compulsions or both. • A person who shows sign of infatuation or fixation with a subject/object, or displays traits such as perfectionism – does not necessarily have OCD. • To be diagnosed with OCD, • One must have with either obsessions or compulsions alone, or obsessions and compulsions, according to DSM-IV-TR.

31. Obsessions are defined by: • Recurrent and persistent thoughts, impulses or images – intrusive, inappropriate and marked anxiety or distress. • The thoughts, impulses or images are not simply excessive worries about real-life problems • The person attempts to ignore or suppress such thoughts, impulses or images or to neutralise them with some toher thought or action. • The person recognises that the obsessional thoughts, impulses or images are a product of his/ her own mind and are not based in reality. • Worries of: • Contamination by germs; Whether they performed a specific action; • Turning off the stove or locking the door; Aggression; Religion; Sex

32. Compulsion are defined by: • Repetitive behavioursor mental acts that the person feels driven to perform in response to an obsession, or according to rules that must be applied rigidly. • Behaviours or acts are aimed at preventing or reducing distress or dreaded events or situation • BUT they are not connected in a realistic way. A person with OCD: • Know the act is senseless but cannot resist to perform without experiencing intolarable anxiety • Anxiety is only relieve by doing the action • Act is very time-consuming (ie taking up more than 1 hour per day) • Act interferes with normal activities and relationships with others.

33. Obsessive-Compulsive Disorder (OCD) • Often causes feelings similar to those of depression • 75% of OCD involve cleaning or checking • Sometimes, reflect superstitious thinking that msut be done to ward off danger • Occurs 2% - 3% in different countries such as US, Canada, Korea, Germany, New Zealand and Puerto Rico. Treatment: • Behavioral treatment combine exposure and response prevention – Clients repeatedly expose to stimuli that will provoke obesession – prevent them from engaging in rituals. • Medications – Serotonin (i.e. Prozac, Anafranil) – Disadvantage: Relapse very high once medication is discontinued.

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