PSYCHOLOGICAL DISORDERS Copyright 1998 Allyn & Bacon.
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Transcript of PSYCHOLOGICAL DISORDERS Copyright 1998 Allyn & Bacon.
PSYCHOLOGICAL PSYCHOLOGICAL DISORDERSDISORDERS
Copyright 1998 Allyn & Bacon
What Is Normal and What Is Normal and Abnormal?Abnormal?
A man kissing another
man
A man kissing another
man
A woman slapping a
child
A woman slapping a
child
A man driving a nail through his
hand
A man driving a nail through his
handA woman refusing to
eat for several days
A woman refusing to
eat for several days
A man barking
like a dog
A man barking
like a dog
Perspectives on Causes and Perspectives on Causes and Treatment of DisordersTreatment of Disorders
Biological Perspective Psychodynamic Perspective Learning Perspective Cognitive Perspective Humanistic Perspective
Copyright 1998 Allyn & Bacon
What is Abnormal?What is Abnormal?
Textbook: “3 D’s”DistressingDysfunctionalDeviance
Abnormal BehaviorAbnormal Behavior
SchizophreniaSchizophrenia Based on observation and self report Signs and Symptoms
Abnormal content of thought Illogical form of thought Distorted perception Changed affect Impaired sense of self Impaired interpersonal functioning
Onset TimingOnset Timing
Period of greatest susceptibility
10 20 30 40 50
AGE
Distinguishing featuresDistinguishing features
flat, dull, inappropriate mood, blank stare confused thinking, rambling train of
thought detachment, absorption in private world severely reduced motivation, indecision
Positive Symptoms of SchizophreniaPositive Symptoms of Schizophrenia
Hallucinations Delusions Disturbances in Form of Thought or
Speech Grossly Disorganized Behavior Inappropriate Affect
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Negative Symptoms of SchizophreniaNegative Symptoms of Schizophrenia
Social Withdrawal
Apathy Loss of
Motivation Lack of Goal-
Directed Activity
Very Limited Speech
Slowed Movements
Poor Hygiene and Grooming
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Types of SchizophreniaTypes of Schizophrenia
Catatonic Disorganized Paranoid Undifferentiated
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Causes of SchizophreniaCauses of Schizophrenia
Genetic Inheritance Excessive Dopamine Activity
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Ventricle ExampleVentricle Example
Cortex Cross-Sections
Normal Schizophrenic
Genetics?Genetics? Psychopathology has been noted among
children of mothers with schizophrenia than among children in the general population: the population risk for schizophrenia is 1 percent, but the risk for children whose mothers have chronic schizophrenia is 16 percent -- and even higher if the father also has schizophrenia or is in the schizophrenia spectrum (Kallmann 1938; Parnas et al. 1993).
Types of SchizophreniaTypes of Schizophrenia
Type I positive symptoms sudden onset responds to antipsychotic meds rapidly
Type II negative symptoms poor response to antipsychotic meds brain atrophy???
Phases of SchizophreniaPhases of Schizophrenia
Acute Episode Rapid deterioration, weeks or months
Prodromal The term "prodrome" is derived from the
Greek word prodromos meaning the forerunner of an event (Fava and Kellner 1991). In clinical medicine, a prodrome refers to the early symptoms and signs of an illness that precede the characteristic manifestations of the acute, fully developed...........
illness. For example, measles is described as having a prodrome of 3 to 4 days characterized by fever, coryzal symptoms, conjunctivitis, and cough. This is followed by the specific rash, making definitive diagnosis possible (Yung and Stanley 1989).
Prodromal....Prodromal.... clear deterioration not due to substances
Typical symptoms marked social isolation or withdrawal impairment in role functioning markedly peculiar behavior digressive, vague or poverty of speech odd beliefs or thinking unusual perceptual experiences
Residual Phase Psychotic features may be absent Sense of apathy Difficulties in thinking, language Harboring unusual ideas
Subtypes of SchizophreniaSubtypes of Schizophrenia Catatonic: rigid posturing, stupor Disorganized: silly, giddy, emotional Paranoid: Delusions of persecution, often
anger Undifferentiated type: multiple Residual type: Previous episodes, currently
not psychotic, mild signs
Other PsychosisOther Psychosis Schizophreniform Disorder: same
symptoms, 1 - 6 months Schizoafftective Disorder: hallucinations,
delusions plus mood disturbances Delusional Disorder Brief Psychotic Episode Substance Induced Psychotic Disorder Psychotic Disorder due to....(specific
medical condition)
TreatmentTreatment Childers (1964) concludes that the combination
of ECT and drug increases the percentage of patients who attain a moderate or better improvement.
Core positive symptoms (e.g., hallucinations, delusions, thought disorder) appear to be significantly reduced by benzodiazepines in some but not all studies.
Based on limited data, Plasky (1991) found little evidence of any efficacy of tricyclic antidepressants for the negative symptoms of schizophrenia
ECT treatmentECT treatment
Erwin and Thompson (1978) believe that ECT does not treat the schizophrenic process but rather treats secondary mood disorders in schizophrenia
Patients with schizoaffective disorder and catatonia had the best response rate (85% and 82%, respectively) to ECT.
““Talk Therapies”Talk Therapies”
Psychotherapy goals are around management of disorder rather than “cure”.
Family therapy is vital to assist in coping. Deal with related emotions....anxiety,
depression, frustration, anger
Mood DisordersMood Disorders
Major Depressive Disorder Seasonal Depression Bipolar Disorder
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Major Depressive DisorderMajor Depressive Disorder
Overwhelming feelings of sadness, despair, hopelessness
Loss of interest in pleasurable activities
Common SymptomsCommon Symptoms
Mood swings Tearfulness Irritability Apathy Loss of energy Concentration/attention problems Indecision Pervasive mood of sadness
Symptoms.....Symptoms..... Negativity and pessimism Guilt, self-reproach Psychomotor retardation or agitation Changes in appetite, weight Sleep difficulties Thoughts of death or suicide Withdrawal Feelings of hopelessness
Variations in DepressionVariations in Depression ReactiveReactive Endogenous, chronicEndogenous, chronic Drug inducedDrug induced Medically related (surgery, Medically related (surgery,
postpartum)postpartum) BereavementBereavement Agitated depressionAgitated depression Seasonal Affective DisorderSeasonal Affective Disorder
Dual DiagnosisDual Diagnosis
Substance abuse and psychological disorder
Depression common Schools of thought
alcohol causes depression (depressant)
depression leads to use of alcohol
When depression goes untreated, its When depression goes untreated, its most tragic cost is suicide. Fifteen most tragic cost is suicide. Fifteen percent of people in whom percent of people in whom depression is overlooked, untreated, depression is overlooked, untreated, or improperly treated, will commit or improperly treated, will commit suicide. This means about 20,000 suicide. This means about 20,000 lives each year, in North America lives each year, in North America alone.alone.
Depression and Depression and SuicideSuicide
TreatmentTreatment
there are two very effective treatments for depression--medication and psychotherapy
almost 80% of people with depression improve with these treatments
depression becomes more difficult to treat the longer its symptoms go untreated
without proper treatment, 10 to 15% of people who suffer depression commit suicide.
St John’s Wort There is considerable There is considerable
public interest in claims public interest in claims that extracts from the herb that extracts from the herb Hypericum perforatumHypericum perforatum, , commonly known as St. commonly known as St. John’s wort, may be an John’s wort, may be an effective treatment for effective treatment for depression. Although St. depression. Although St. John’s wort is widely John’s wort is widely prescribed in Europe, prescribed in Europe, clinical research in the USA clinical research in the USA is incompleteis incomplete..
Gender & DepressionGender & Depression
(Data from Kessler, et al., 1994)
Prognosis (1 year)Prognosis (1 year)
(APA Data, 1994)
Seasonal Affective DisorderSeasonal Affective Disorder
A greater than normal mood fluctuation with the seasons
Related to amount & intensity of light
Seasonal Affective DisorderSeasonal Affective Disorder
(After Wurtman & Wurtman,1989)
Bipolar DisorderBipolar Disorder
Manic episodes & extreme depression mixed with normal affect
Mania involves delusional levels of optimism, euphoria, & energy
Equally common in both sexes Sufferers make poor decisions while manic,
withdraw when depressed
Bipolar DisorderBipolar Disorder
(Data from Kessler, et al., 1994)
Genetic ConnectionGenetic Connection
Moderate in major depressive disorder
Strong in bipolar depression
Causes & TreatmentsCauses & Treatments
Depression:
low norepinephrine & serotonin levels
Mania:
high norepinephrine levels
Major Depressive Disorder:
serotonin selective reuptake inhibitors (e.g. Prozac)
Causes & TreatmentsCauses & Treatments
Bipolar Depression:
lithium carbonate
Neurotransmitter levels may be symptomatic of depression, not causal
Cognitive theory attributes depression to distorted thinking
Distorted ThinkingDistorted Thinking
Includes negative views of the world, the future, the self
Tied to poor reality testing, learned helplessness
Causes of Major Depression Causes of Major Depression and Bipolar Disorderand Bipolar Disorder
The Biological Perspective The Cognitive Perspective
The Psychodynamic Explanation
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Anxiety DisordersAnxiety Disorders
Generalized Anxiety Disorder Panic Disorder Phobias Obsessive-Compulsive Disorder
Copyright 1998 Allyn & Bacon
Anxiety DisordersAnxiety Disorders
Fears & Phobias
Obsessive Compulsive
Disorder
Generalized Anxiety Disorder
Panic Disorder
Phobias: Lifetime PrevalencePhobias: Lifetime Prevalence
Obsessive CompulsivesObsessive Compulsives
Obsessions: persistent, uncontrollable thoughts
Obsessive CompulsivesObsessive Compulsives
Compulsions: intrusive, inappropriate actions that often prevent obsessions
Obsessive CompulsivesObsessive Compulsives
Obsessions
Anxiety
Compulsions
Reduce
Somatoform DisordersSomatoform Disorders
HypochondriasisConversion Disorder
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Dissociative DisordersDissociative Disorders
Dissociative Amnesia Dissociative Fugue Dissociative Identity Disorder
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Other Psychological DisordersOther Psychological Disorders
Sexual and Gender Identity Disorders
Personality Disorders
Copyright 1998 Allyn & Bacon