Module 47

1. Module 47 Introduction to Psychological Disorders Module 47& 48

2. Medical Student Disease -- A warning Module 47& 48

3. How Can we define abnormal Behavior? 1) Clinically significant - serious enough to warrant professional attention. • distress • disabling • dangerous to the person or to others. Module 47& 48

4. 2) Internal Source - stems from within 3) Involuntary Manifestations Module 47& 48

5. Labeling and Psychological Disorders • Rosenhan and 8 mentally healthy associates, ("pseudopatients“) were admitted to psychiatric hospitals by feigning auditory hallucinations (the words "empty", "hollow", "thud“) • None had a history of mental illness. • After admission symptoms disappeared and pseudopatients asked to be released.  Module 47& 48

6. Their stays ranged from 7 to 52 days, and the average was 19 days.  • All were discharged with a diagnosis of schizophrenia "in remission," which Rosenhan takes as evidence that mental illness is perceived as an irreversible condition creating a lifelong stigma rather than a curable illness. Module 47& 48

7. Despite constantly and openly taking extensive notes on the behavior of the staff and other patients, none of the pseudopatients were identified as impostors by the hospital staff, although many of the other psychiatric patients seemed to be able to correctly identify them as impostors. • Labels can effect perceptions of behaviors. • Self-fulfilling prophecies Module 47& 48

8. Factors Effecting Psychological Disorders 1) Predisposing factors - in place before the disorder begins. (Genetic, learned, societal) 2) Precipitating Causes current stressors. 3) Maintaining Causes - rewards (e.g., attention, avoidance of responsibilities) Module 47& 48

9. Diagnostic and Statistical Manual of Mental Disorders (DSM -5 ) - specifies criteria (symptoms) for diagnosis. - attempt to increase reliability of diagnosis. DSM IV has 16 categories (each with several sub-categories). Module 47& 48

10. Anxiety Disorders Mood Disorders Somatoform Disorders Substance-related Sleep disorders Eating Disorders Adjustment disorders Factitious disorders Personality disorders Module 47& 48

11. Psychological factors affecting medical disorders Dissociative Disorders (Amnesia; DID) Schizophrenia and psychotic disorders Sexual and Gender Identity disorders Impulse control disorders Disorders diagnosed in childhood or adolescence Delirium, dementia, amnesia & cognitive disorders. Module 47& 48

12. Module 48 Anxiety Disorders Module 47& 48

13. Anxiety and Avoidance Disorders Fear - specific item, situation or thought. Anxiety - vague, unspecified generalised fears or future fear. Easiest to treat (goodprognosis). Module 47& 48

14. Generalized Anxiety Disorder (GAD) • exaggerated worry and tension, often expecting the worst, even when there is no apparent reason for concern. • They anticipate disaster and are overly concerned about money, health, family, work, or other issues. • Free-floating anxiety Module 47& 48

15. GAD is diagnosed when a person worries excessively about a variety of everyday problems for at least 6 months • GAD develops slowly. It often starts during the teen years or young adulthood. • More common in women, • Rare after age 50. • Symptoms may get better or worse at different times, and often are worse during times of stress. Module 47& 48

16. Panic Disorder • Physiological symptoms • e.g., heart racing, shortness of breath • Psychological Symptoms • e.g., fear of losing control or dying • feeling of unreality • Nicotine (stimulant) use doubles the risk of having Panic disorder Module 47& 48

17. Causes - genetics - brain abnormalities - mis-interpretation of physical symptoms. - Catastrophic Thinking Extreme case: Agoraphobia Fear of being separated from a safe place. - often can not leave their homes without a "safe" person. - more common in women. Module 47& 48

18. Phobias - intense, irrational fear of specific objects or events. Specific Phobias - fear of something specific - Usually arise in middle childhood - more common in females. • prevalence 30 to 40% Module 47& 48

19. Some Examples Fear of: Acrophobia heights Claustrophobia enclosed places Hematophobia blood Gephyrophobia crossing a bridge Kenophobia empty rooms Aichmophobia sharp pointed objects Aquaphobia Water Cynophobia dogs Aerophobia flying Entomophobia insects Gamophobia marriage Ophdophobia snakes Xenophobia strangers Melissophobia Bees Homilophobia Sermons Porphyrophobia the color purple Module 47& 48

20. Module 47& 48

21. B) Social Phobias excessive fear of being scrutinised or evaluated - Avg. age of onset 19 - equal for males and females - without intervention lifelong (chronic) Module 47& 48

22. Obsessive Compulsive Disorder (OCD) Obsessions - recurrent thoughts, impulses, or images -intrusive, inappropriate and cause distress. Compulsions repetitive behaviours Goal to reduce anxiety but not realistic prevention. - tends to begins before age 15 - genetic Module 47& 48

23. Common Types Checking Behavior Cleaning Behavior Washing Rituals Therapy Exposure Therapy Drug Therapies Clomipramine and Prozac - increases seratonin Module 47& 48

24. Post Traumatic Stress Disorder • Re-experiencing of traumatic events • dreams or thoughts • irritability • sleep problems • difficulty concentrating Video Module 47& 48

25. Treatments - exposure therapy (systematic desensitization) - cognitive therapy - EMDR Drug Therapies Tranquilizers (Valium, Xanax) - temporary solution - habit forming Clomipramine and Prozac - increases serotonin Module 47& 48

26. Module 49 Mood Disorders Module 49 - Mood disorders

27. Depressed mood Loss of interest in pleasurable activities Decrease or increase in appetite OR significant weight loss or gain Persistently increased or decreased sleep Psychomotor agitation or retardation Fatigue or low energy Feelings of worthlessness or inappropriate guilt Decreased concentration or indecisiveness Recurrent thoughts of death, suicidal ideation, or suicide attempt Major Depressive Episode Five or more symptoms present for ≥ 2 weeks

28. Most depressions last less four months. 1/2 who have one episode never have another. 1/4 have a multiple recurrence. According to NAMI The lifetime risk of suicide for patients whose depression goes untreated is nearly 20%, the risk for treated patients is a mere 0.141%. Suicide was the second leading cause of death for adults between the ages of 10 and 34 years in the United States. Module 49 - Mood disorders

29. According to NAMI (2012) The lifetime risk of suicide for patients whose depression goes untreated is nearly 20%, the risk for treated patients is a mere 0.141%. Suicide was the second leading cause of death for adults between the ages of 10 and 34 years in the United States. Module 49 - Mood disorders

30. Preventing Suicide If someone tells you they are thinking of suicide . . . 1) Take it seriously 70% tell someone before hand. 2) Talk to them about it 3) Recognise symptoms - giving away possessions - sudden recovery from depressed mood 4) Don’t leave them alone! Module 49 - Mood disorders

31. 5) Encourage them to get help . . . . and Get help yourself . 6) Discourage Drinking. Alcohol is a depressant. It just makes it worse! Module 49 - Mood disorders

32. Symptoms of Mania • - abnormal, persistent elevated or irritable mood • - inflated self esteem or grandiosity • - decreased need for sleep • - uncontrolled talking • racing thoughts • - excessive risky activities (spending sprees, sexual indiscretions, foolish business investments) • - generally develops before 30 • - if untreated episodes last from 2 to 6 weeks Module 49 - Mood disorders

33. Bipolar Disorder reoccurring episodes of depression and mania often with normal moods in between. Hypomania – less sever mania Dysthymia - less sever depression. Cyclothymia - less sever bipolar disorder - generally begin in early adulthood and rarely leads to suicide. Module 49 - Mood disorders

34. Causes of mood disorders

35. Causes Biological Perspective Genetics - twin Studies - linkage Studies Brain Activity Neurochemicals - Norepinephrine and Seratonin Module 49 - Mood disorders

36. Social Cognitive Perspective Learned Helplessness Rumination (Negative Thoughts) - state dependant memories Module 49 - Mood disorders

37. Social Cognitive Perspective Explanatory Style Module 49 - Mood disorders

38. StressorsReactive Depression - response to an identifiable stressor(s). Poor coping strategies Module 49 - Mood disorders

39. Drug Therapy Serotonin & norepinephrine Tricyclics Monoamine Oxidase Inhibitors Prozac Family Cognitive Therapy – Challenge Stinking Thinking Module 49 - Mood disorders

40. Drugs or Talk Therapy --- Which works best? Both Work. The combination: - works better for people with Major Depression - decrease probability of re-occurrence Module 49 - Mood disorders

41. Module 50 Schizophrenia

42. Schizophrenia – break with reality (psychosis) - lifetime prevalence 1% Symptoms Delusions - false beliefs despite clear evidence to the contrary - delusions of control. - delusions of grandeur. • delusions of reference • delusions of persecution

43. Hallucinations - seeing and hearing things that are not there. Disorded Thoughts - unusual associations Flat Affect or Inappropriate Emotions and Action

44. Subtypes Paranoid Type - delusions of persecution - well organized delusions Disorganised Type - speech disorganisation (word salads) - poorly developed delusions

45. Catatonic Schizophrenia Motor symptoms Waxy inflexibility - remain in same position Undifferentiated Schizophrenia

46. Statistics

47. Causes of Schizophrenia - genetics - triggered by environmental factors (illness, stress) • Dopamine Over activity • Maternal Virus During Midpregnancy Amphetamine Psychosis- drugs that increase dopamine (amphetamines, cocaine, angel dust) increase symptoms in schizophrenics and produce symptoms in normals.

48. Module 51 Personality Disorders

49. Personality Disorders - stable (long-term) - extreme personality characteristics - impair functioning and/or social relationships Cluster A: Odd-Eccentric Personality Disorders Paranoid, Schizoid and Schizotypal Disordered Thought Patterns - genetically linked to schizophrenia - no psychosis

50. Paranoid Personality Disorders Feel “everyone and everything is out to get them”. - misinterpret situations in line with this paranoia - intensifies under stress - May act on these feelings. Treatment - Cognitive Therapy to increase self- efficacy for dealing with problems. - does not challenge paranoid beliefs.