Psychological Disorders

1. Psychological Disorders Specific Disorders for our BIG “Landscape” Notes Created by Andy Filipowicz Ocean Lakes High School, 2008

3. Definitions of Mental Disorder 1- Mental disorders as a violation of cultural standards or atypical 2- Mental disorder as maladaptive or harmful behavior 3- Mental disorder as a disturbing emotional distress. 4- Mental disorder asunjustifiable

4. Psychological Disorders According to the Law M’Naghten Rule  1) must not know what you are doing is wrong OR 2) must not understand the nature of the act Stats on “legal insanity”… Discuss: Are the mentally insane more dangerous? Several articles on “legal insanity” and more

5. Discussion Day 59 • Why do we diagnose people with psychological disorders? What exactly is the purpose of this anyway? • What might be some potential benefits? Potential negatives/side effects of such a diagnostic system? Let’s discuss a few ideas…

6. Diagnostic & Statistical Manual of Mental Disorders • DSM-IV (1994) contains more than 300 mental disorders. (DSM-V to be released in May 2012) • Provides diagnostic categories • Does not provide information on causes • Does not provide information on treatment • It is organized in 5 axes

7. The Five Axes • I = Categories of Psychological Disorders • II = Personality & Developmental Disorders • III = Medical Conditions • IV = Rating of Recent Social & Environmental Stress • V = Global Assessment of Functioning (GAF) from 1-100 (1 = severe dysfunction)

8. Discussion • What are some remaining issues stemming from this system of classification? • Boundary btwn normal / abnormal • Cut-offs for number of symptoms seems random and arbitrary • How are specific time periods for symptom duration chosen? • Auxiliary axes (premorbid history, quality of relationships, work and family functioning)

9. Understanding Psychological Disorders The Biomedical Model Psychological disorders are sicknesses and can be diagnosed, treated, and even cured. The Bio-Psycho-Social Model How biological, psychological, and social factors interact to produce specific psychological disorders.

10. Anxiety Disorders • 1- Panic Disorder • 2- Generalized Anxiety Disorder (GAD) • 3- Posttraumatic Stress Disorder (PTSD) • 4- Phobias (fears) • 5- Obsessive-Compulsive Disorder (OCD)

11. 1 – Panic Disorder Panic Attack • Symptoms • “recurrent, unexpected” • acute episode of intense anxiety without any apparent provocation • Can’t breathe, heart pounding ,sweat, shake, feel like you’re losing your mind • Additional anxiety comes from anticipating future attacks  this is actually what the disorder is (panic attacks are actually separate from the disorder; can have 1 without the other! (Abnormal book Pg. 117  Gretchen  Attacked by Panic) • Cause – based on perspective • NOT caused by a stressful event • LIKELY original cause  physiological event (out of breath) and then an unrelated troublesome thought (death of mother) • Increase in frequency following 1st panic attack • Low levels of GABA = inc anxiety • Genes  tendency to be tense/uptight • Smoking incs likelihood of developing anxiety disorders

12. 1 – Panic Disorder – Stats and Treatment • With or without agoraphobia (5.3% have this by itself)? • Fear and avoidance of situations in which they would feel unsafe in the event of a panic attack or symptoms • Abnormal book pg. 126 (Mrs. M – Self-Imprisoned) • 3.5% some point in their lives • 2/3 women • Men drink • Women develop this agoraphobia • Onset mid-teens to 40 • Puberty is best predictor • Less pervasive in elderly • Benzodiazepines/SSRIs = Prozac, Paxil, Xanax

13. 2 – Generalized Anxiety Disorder (GAD) • (abnormal book pg. 121 – Irene) • A general feeling of impending doom • Continually tense / jittery (from constant high-levels of anxiety) • Muscle fatigue, tension common • Worried that bad, horrible things might happen • Autonomic System Arousal • racing heart, clammy hands, stomach butterflies, sleeplessness, twitching eyelids, fidgeting • Cause: no specific cause • Genes: tendency to be tense • Learning: important events in life are uncontrollable/dangerous • Stress makes them apprehensive, vigilant

14. 2 – GAD Stats • 5% at some point • 2/3 female • Gradual onset, though first appears following a major life change beginning in early adulthood (leaving home, getting a new job, having a baby, etc.) • Chronic • Very prevalent in elderly • Treatment: Hardest of the Anxiety Disorders to treat • Valium, Librium • Cognitive Behavioral Therapy  purposefully confront anxiety-provoking images and thoughts…develop strategies for dealing with these

15. 3 – Posttraumatic Stress Disorder (PTSD) • SYMPTOMS: flashbacks, nightmares, intrusive thoughts, intense physiological reactivity • CAUSES: • When people are in danger, they produce high levels of natural opiates, which can temporarily mask pain. They also produce stress hormones. • People with PTSD tend to continue producing these hormones. • Norepinephrine is higher than normal. It activates the hippocampus, which is involved with memory and long term memory. • At high levels, stress hormones can become toxic and can damage the brain. • Triggered by a life threatening trauma • Men: War • Women: Rape • 25% of those experiencing a life threatening event develop PTSD

16. 3—PTSD – Stats / Treatment • Group therapy  helps us to mimic normal relationships again • Behavioral therapy  experience the conditioned stim/response as NOT always together or anxiety will always persists • Systematic Desensitization

17. 4 – Phobias • Acrophobia: fear of heights • Brontophobia: fear of thunder • Astraphobia: fear of lightning • Claustrophobia: fear of closed places • Porphyrophobia: fear of the color purple • Mysophobia: fear of dirt and germs • Agoraphobia: fear of being away from a safe place. • Triskaidekaphobia: fear of number 13 • Phobophobia

18. 4 – Phobias – 3 Classes • Specific (over 700, but not in DSM) • Search for Phobias • Social – avoidance of social situations • 13.3% of pop at some point (35mil) • 1.4F: 1M • Peak onset = 15yrs • Agoraphobia • Cause: • Inherited = falling, loud noises, social  seen in infants 4 months old • Behavioral = observation, vicarious (latent) experience Moving Images: 24: Intensive Exposure Therapy

19. 5 – Obsessive-Compulsive Disorder (OCD) • Obsessions = Recurrent, persistent, unwished-for thoughts or images. • Example: repetitive thoughts about killing a child or becoming contaminated by shaking hands. • Compulsions = Repetitive, ritualized behaviors that the person feels must be carried out to avoid disaster. • Example: hand washing, counting, & checking (door locked, curling iron off)

20. 5 – OCD – Causes • Video  Moving Images: 22 OCD or OCD VHS • 2.6% at some point • 55-60% female (in kids though, ratio is reversed) • Onset around 20, doesn’t show up past 30 • Boys develop OCD earlier • Article  Strep throat! • High activity in front lobe just above the eyes • Freud = Anal Retentive • NT = lack of serotonin • Link to Tourette syndrome and Dopamine • Organic = brain tumors, injuries, stress, viruses • 1918 flu epidemic spiked encephalitis also increased OCD cases • Brain = abnormally high levels of activity in the caudate nucleus, part of the basal ganglia known to be involved in initiation of learned behavior

21. Somatoform Disorders • Defined = psychological problem manifested in a physiological symptom (see overhead slides) • A - Conversion Disorder • B - Hypochondriasis • C – Body Dysmorphic Disorder

22. Conversion Disorder • NOT FAKING IT • Paralysis of a limb (most common) • Total paralysis • Weakness • Insomnia • Blurred vision, deafness, other sensory effects • Pain – back, abdominal • Peak onset = mid-late 30s • “Shell shock” during WWI/II

23. The patient has one or more symptoms or deficits affecting the senses or voluntary movement that suggest a neurological or general medical disorder.  • The onset or worsening of the symptoms was preceded by conflicts or stressors in the patient's life.  • The symptom is not faked or produced intentionally.  • The symptom cannot be fully explained as the result of a general medical disorder, substance intake, or a behavior related to the patient's culture.  • The symptom is severe enough to interfere with the patient's schooling, employment, or social relationships, or is serious enough to require a medical evaluation.  • The symptom is not limited to pain or sexual dysfunction, does not occur only in the context of somatization disorder , and is not better accounted for by another mental disorder.

24. Hypochondriasis

25. Body Dysmorphic Disorder • “distorted body image” • Size, shape, form • Perception of physical appearance • 50% get plastic surgery • Equal gender ratios • Onset: late childhood, early adolescence (avg age is 17)

26. Dissociative Disorders • ?- Amnesia • @- Fugue • #- Dissociative Identity Disorder (Multiple Personality Disorder)

27. ?- Dissociative Amnesia • Unable to recall important personal information or past events (name, origin, relationships, job, etc.) • General amnesia is anything at all (procedural stuff is fine though  ride a bike, how to talk, etc.) • Selective amnesia is specific traumatic events (war) • Cause (all Dissociative Disorders): attempt to escape from traumatic event (past or present) • Abnormal book: 179: The Woman who Lost Her Memory

28. @- Fugue • Memory loss is accompanied by an unexpected trip • Confusion about personal identity • 0.2% of pop • Therapy: Psychotherapy to deal with original traumatic event • Prognosis: A few months • Abnormal book: 180: The Misbehaving Sherif

29. #- Dissociative Identity Disorder(Multiple Personality Disorder) • IT IS NOT SCHIZOPHRENIA; IT’S TOTALLY DIFFERENT!!!!!!!! THIS WAS AN AP ESSAY QUESTION! • Loss of time • Onset = 2-12 yrs old • At least 2 personalities, 10 is avg • Personalities have different names, sexes, ages, voices, facial expressions, handwriting, physical problems • Often at least 1 is quite violent, aggressive (FIGHT CLUB!)

30. #- Dissociative Identity Disorder(Multiple Personality Disorder) • Almost non-existent outside of North America • India, Japan entirely nonexistent • Self-multilation • EXCELLENT MEMORY!!! (when not in the alter egos) • Some can function in a “normal” life • Cause: physical, sexual, psychological abuse (not all who are abused will develop it, but it’s a good place to look for a cause if someone has it) • Video: Brain 23 Multiple Personality • May involve role playing as normal subjects under hypnosis will express 2nd personality if instructed to do so by the psychologist/hypnotist • 85% are female (http://skepdic.com/mpd.html)

31. Mood Disorders • - Major Depression (think Unipolar) •  &  Bipolar Disorder aka Manic Depression MIND 32: Mood Disorders: Hereditary Factors

32. Symptoms of Depression Pg. 195 (Katie) Psychological Symptoms • Feeling of despair, hopelessness, worthlessness, intense sadness #1 symptom • Exaggerating minor failings and ignoring positive events • Interpreting losses as signs of personal failures and concluding that happiness is not possible. Physiological Symptoms • Insomnia/Hypersomnia, lack of appetite trouble/ overeating, trouble concentrating, early morning wakeups • DEBILITATING  can’t go to work/school VIDEO: Moving Images: 23: Depression

33. Causes / Stats of Depression • 1 more thing about symptoms: to be clinical depression, symptoms must persist for at least 2 weeks in the absence of a clear reason • If only during winter months (no sunlight = more melatonin = sleepy), SAD = Seasonal Affective Disorder • Neurotransmitters: lack of serotonin, norepinephrine • Lower activity in left frontal lobe • Freud: “anger turned inward” • Onset: mean = 25-29, though age of onset is going down [3 month olds (207)] • Average duration of 1st episode = 6-9 months • 70% are women • Dysthmyic Disorder = chronic, lasting at least 2 years, not episodes, its chronic! But less severe…(not debilitating) (Double Depression = Dysthymic Disorder with occasional bouts of depression • + common than bipolar, - common than phobias Moving Images 23: Mike Wallace

34. MANIA Excessive production of 1 or 2 NTs: 1-Norepinephrine 2-Serotonin DEPRESSION Low levels of 1 of 2 NTs: 1-Norepinephrine 2-Serotonin NT Causes of... Mind: 31: Mania & Depression

35. Mania • An abnormally high state of exhilaration • Extreme pleasure in every activity (cleaning, shopping, etc.) • Flight of ideas – lots at once • Excessive energy • Irrational decisions • Feeling of excessive hopefulness • Speaking rapidly and dramatically • Excessive feeling of ambition / grandiosity • Inflated self esteem Pg. 202 abnormal book – Billy

36. Stages of Mania • 1-Hypomania Patients are energetic, extroverted, and assertive • 2-Mania Loss of judgment • 3-Delusion with Paranoid Themes Speech is generally rapid and hyperactive behavior may lead to violence.

37. Bipolar DisorderManic-Depressive • When people alternate between episodes of depression and one or more episodes of mania. • Occurs equally in both sexes. • Mean onset is between 18-22, though 1/3 of cases actually begin in adolescence • 50/50 M/F • Those who have rapid cycling may experience more episodes of mania and depression that succeed each other without a period of remission. • Less common than depression

38. Bipolar DisorderManic-Depressive • Cyclothymic Disorder =

39. People Who Had Bipolar • Abraham Lincoln Edgar Allan Poe • Van Gough Virginia Wolf • Vivian Lee Walt Whitman • Charles Dickens Ernest Hemingway • Isaac Newton • Mark Twain Mind 34: ECT for Depression

40. SAD • Seasonal Affective Disorder • 5% of North Americans • 2% of Floridians • 10% of New Hampshirians

41. Schizophrenia • Overall must have at least 2 of the following 5: • Delusions (+) • Hallucinations (+) • Disorganized Speech (mostly +) • Disorganized Behavior (inappropriate or ineffective behavior) (mostly +) • Negative Symptoms

42. Schizophrenia – General Characteristics • delusions = • Delusions of Persecution (CIA watching) • “the doctor is out to get me” “that picture is meant for me” Beautiful Mind: codes in the newspaper • Delusions of Grandeur (God-like, the president, Nobel Prize winner, savior of the world, etc.) • Capgras Syndrome: someone you know replaced by a double • Cotard’s Syndrome: thinks a part of the body has changed in some impossible way

43. Schizophrenia – General Characteristics • Disturbed Perceptions = Hallucinations • Seeing / hearing / feeling usually • Somatic hallucinations – “snakes are crawling around on me” • Hearing voices (auditory hallucinations – most common) • interestingly, we find problems in Broca’s area (NOT wernicke), so it’s not language composition, but as if one’s own produced language is repeated in the head as other people’s voices & the person can’t tell the diff

44. Schizophrenia – General Characteristics • Disorganized speech & Thought • Lack insight, awareness of problem • Jump from topic to topic, talk illogically • Tangentiality, loose association • Overinclusion (word associations guide speech “For dinner we had veal cutlets, tossed salad, and French fries, with lots of German, Polish, Spanish, and the United Snakes) • Paralogic: “President Bush is a Texan. I come from Houston, TX. I’m the President.” • Thought insertion or withdrawal

45. Schizophrenia – General Characteristics • Disorganized behavior = Inappropriate or ineffective behaviors • Ex: wearing winter clothing on a hot day • Ex: crying, laughing at inappropriate times • Catatonia – no movement (- symptom) OR rigid fixed behaviors • Flat Affect – no emotion (- symptom)

46. Negative Symptoms • Affective Flattening (2/3 have this) = don’t show emotion in situations where you’d expect it • Anhedonia = inability to feel pleasure; indifference • Alogia = lack of meaningful speech • Avolition = lack of motivation • Cessation of personal hygiene

47. Other symptoms • Dissociative symptoms • Anosognosia • High rates of substance abuse disorders • High risk of suicide • High rate of OCD / Panic Disorder • Downward drift

48. Onset of Schizophrenia • Chronic / Process schizophrenia • Slow developing process • Recovery doubtful • Acute / reactive schizophrenia • Previously well-adjusted person, in reaction to life’s stresses, rapidly develops schizophrenia; recovery more likely

49. Onset statistics • Average age of onset = 15-30 • Men = usually younger than 25 • Women = 26-45 • 1 % worldwide • EQUAL M/F • Men  likelihood of onset decreases with age (possible after even age 75) • Women  lower likelihood until age 36, then higher • Kids do show abnormal signs • (more -, less +) • 78% have several episodes, not just 1 • In US, Af-Am are diagnosed at a higher rate than whites. WHY? • Could be a bias in who is tested

50. Neurotransmitters  dopamine • Over-activity of DA (impaired attention) • Over-sensitivity of DA receptors • Drugs mimicking DA (amphetamines, cocaine intensify symptoms b/c they too increase DA levels) • Anti-psychotic drugs reduce symptoms by blocking receptors for DA