Unit 6Psychological Disorders and Their Treatment

I. History of Mental Illness

A. In ancient civilizations many people believed that bizarre behaviors was the result of evil spirits and demons.

- Tortured individuals to get rid of demons - Trephination – drilling or scraping a hole into the human skull to release demons.

B. Greek physician Hippocrates suggested that mental illness stemmed from natural occurrences in the human body.

- People began to use emetics, laxatives to even out the body fluids - Also used leeches to bleed individuals

C. Although the first mental hospital was established in 792 CE, Most individuals still remained under the care of their family members. D. The stigma surrounding mental illness lead individuals to hide their mentally ill family members in cellars, cage them, and even abandon some.

E. The middle ages were the ages of faith. People believed that individuals who were mentally ill were possessed by demons and that God could cure them.

- Witch hunts

F. The 16th century was the start of the rise of asylums.

- deplorable living conditions - cruel abuse - reformed penal institutions to lift the burden off families and prevent

disturbances in the community.

• G. in the 1840’s Dorethea Dix began a campaign to improve the living conditions of the mentally ill. – Over the next 40 years the U.S. government

established 32 state psychiatric hospitals.

H. In the 1950’s antipsychotic drugs were developed and there was a push for deinstitutionalization.

- only those who posed an imminent danger to themselves or someone else.

- 560, 000 mentally ill in hospitals in 1950’s - 130,000 by 1980

II. The Stigma

A. There are many stigmas surrounding mental illness.

B. Many people fail to get help with their mental illness because of the stigmas.

III. Prevalence

A. 1 in 4 Americans 18 years or older suffer from a diagnosable disorder.

B. 1 in 17 people suffer from a serious mental illness.

C. 1 in 5 Families are affected by mental illness.D. Fewer than one-third of adults and one-half of

children with a diagnosable mental disorder receive mental health services in a given year.

IV. Defining and Identifying

A. Just because an individual is different does not mean that they are suffering from a mental illness.

B. The four D’s to determine mental illness:

Deviance – behavior, thoughts or emotions that are not consistent with social norms, seen as unusual or inappropriate .

Distress – the behavior, ideas, or emotion causes distress to the individual or others.

Dysfunction – interferes with daily function.

Danger – behavior that is dangerous to oneself or others.

V. DSM

A. Psychological problems do not lend themselves to the same sort of categorizing that physical illnesses do.

B. Causes and symptoms of psychological disturbances or the cures are rarely obvious or clear-cut.

C. 1952 American Psychiatric Association develop the Diagnostic and Statistical Manual of Mental Disorders – DSM. It has been revised 6 times. We now use the DSM-5.

VI. Dissociative Disorders

A. A disorder in which a person experiences alterations in memory, identity, or consciousness.

B. 2% of people experience dissociative disorders

C. More common to develop in children

Symptoms of Dissociative Disorders

• Significant memory loss of specific times, people and events

• Out-of-body experiences, such as feeling as though you are watching a movie of yourself – Derealization

• Mental health problems such as depression, anxiety and thoughts of suicide

• A sense of detachment from your emotions, or emotional numbness

• A lack of a sense of self-identity –Depersonalization

Causes of Dissociative Disorders

• Usually develop as a way of dealing with trauma.

• most often form in children exposed to long-term physical, sexual or emotional abuse.

• Natural disasters and combat can also cause dissociative disorders.

Types of Dissociative Disorders

– Dissociative Amnesia/Dissociative Fuge – disorder characterized by the inability to recall important personal events or information; usually associated with stressful events. With Dissociative Fuge a person not only has amnesia but also suddenly and unexpectedly travels away from home or work.

– Depersonalization disorder -ongoing feelings of detachment from actions, feelings, thoughts and sensations as if they are watching a movie.

– Dissociative identity disorder – a disorder in which a person exhibits two or more personality states, each with its own patterns of thinking.

Treatment for Dissociative Disorders

• Psychotherapies (Talk therapies)– cognitive behavioral therapy (CBT) – Eye movement desensitization and reprocessing

(EMDR)

• Medications such as antidepressants or antianxiety medications can treat symptoms of related conditions

VII. Anxiety Disorders

A. The most common type of mental illness in the United States affecting 40 million Adults (18% population)

B. “Anxiety disorder” is a blanket term for several different forms of a psychological disorders that are characterized by overwhelming anxiety – displeasing feelings of fear, concern, unease, or dread.

Symptoms of Anxiety Disorders

C. Symptoms of anxiety disorders include: A. Feelings of panic, fear, and uneasinessB. Uncontrollable and obsessive thoughtsC. Repeated thoughts or flashbacks of traumatic

experiencesD. NightmaresE. Ritualistic behaviors, such as repeated hand

washingF. Problems sleeping

Causes of Anxiety Disorders

A. Chemical Imbalances B. Changes in brain structure C. Heredity D. Environmental factors – trauma or other

significant event

Types of Anxiety Disorders

A. Generalized Anxiety Disorder – extreme worry about every day issues and many other things, even when there is little or no reason to worry about them. At times, interferes with doing everyday tasks.

B. Phobic Disorder - extreme and irrational fear of a particular object or situation.

Examples

C. Panic Disorder – an extreme anxiety that manifests itself in the form of panic attacks

D. Obsessive-Compulsive Disorder - unreasonable thoughts and fears (obsessions) that lead you to do repetitive behaviors (compulsions). http://www.youtube.com/watch?v=zC2G6lf9fCsE. Post-Traumatic Stress Disorder – victims of traumatic events experience the original event in the form of dreams or flashbacks or have trouble coping with the events.

Treatment for Anxiety Disorders

• Therapy – CBT, Exposure, DBT, EMDR• Medication – Benzos, Serotonin Reuptake

Inhibitors, Anti-depressants • Complementary and alternative treatment –

Yoga, meditation, acupuncture

VIII. Schizophrenia

A. A group of disorders characterized by confused and disconnected thoughts, emotions, and perceptions.

B. 1% of Americans have it C. Becomes evident during young adulthood (15-24 men and 25-34 women) D. More common in left handed individualsE. At the top of the list of severe mental

illnesses

Symptoms of Schizophrenia

Positive symptoms (the key charateristics) – Hallucinations – perceptions that have no direct

external cause (ex: hearing a voice when no voice is present).

– Delusions – false beliefs that a person maintains in the face of contrary evidence.

– Thought disorder – difficulty organizing thoughts. –Movement disorder – agitated body movements,

repetitive movement or catatonic.

Additional Symptoms of Schizophrenia

-Negative Symptoms (not always present)– “flat affect”– Lack of pleasure in everyday life– Lack of ability to begin and sustain planned activities – Speaking little even when forced to interact

- Cognitive Symptoms – Poor "executive functioning" (the ability to understand information

and use it to make decisions)– Trouble focusing or paying attention– Problems with "working memory" (the ability to use information

immediately after learning it).

Causes of Schizophrenia

1. Genetics 2. Imbalance in chemicals (dopamine and serotonin) 3. Brain structure

Types of Schizophrenia

- Paranoid type – involves hallucinations and delusions (grandeur persecution).

- Catatonic type – remain motionless for long periods of time.

- Disorganized type – incoherent language, inappropriate emotions, giggling for no apparent reason, generally disorganized

motor behavior, hallucinations and delusions.

- Undifferentiated type – has many symptoms of schizophrenia but does not fit into one of the other types.

- Residual type – anyone whose symptoms are completely gone or diminished from what they were previously.

Treatment for Schizophrenia

• Treatment is life long• Antipsychotics are the cornerstone treatment– Affect dopamine and serotonin levels

• Psychosocial treatments include: – Therapy – Social skills training– Vocational rehabilitation

IX. Somatoform Disorders A. A clinical complaint of symptoms made by a

patient for which there is no physical evidence of disease.

B. Most commonly occur in females, low education and low economic status.

C. They are not faking. The pain is real. D. Can significantly affect daily functioning.

Symptoms of Somatoform Disorders

Symptoms and their severity vary depending on the type of somatoform disorder.

Types of Somatoform Disorders 1. Somatization disorder usually involves pain and severe

neurological symptoms, digestive symptoms.

1. Hypochondriasis occurs when a person believes that normal body functions (such as a grumbling stomach) or minor symptoms (such as a common headache) are symptoms of a very serious disorder.

1. Body dysmorphic disorder occurs when a person becomes obsessed with a flaw in his or her physical appearance that is either a minor flaw or a flaw that doesn't exist.

4. Conversion disorder is when physical symptoms that are similar to a neurological disorder develop (loss of body function), when no neurological disorder is actually present.

5. Pain disorder is similar to somatization disorder, except that pain is the main symptom.

Causes of Somatoform Disorders• Not clearly understood.

• Hypochondria - sensitive to body sensations, or over interpret the meaning of normal body sensations, a distressing memory of childhood illness

• Conversion disorder, somatization disorder, and pain disorder – stress

• Body dysmorphic disorder may be culturally influenced

Treatments for Somatoform Disorders

• Psychotherapy - a person tries to understand and resolve anxiety, trauma, or conflicts that are behind these conditions.

X. Mood Disorders

A. A serious change in mood.B. Approximately 20.9 million American adults, or

about 9.5 percent of the U.S. population age 18 and older in a given year, have a mood disorder.

C. The median age of onset for mood disorders is 30 years.

D. Depressive disorders often co-occur with anxiety disorders and substance abuse.

Symptoms of Mood Disorders • Prolonged sadness or crying spells.• Changes in appetite and sleep patterns.• Irritability, anger, worry, agitation, anxiety• Indifference.• Loss of energy• Feelings of worthlessness• Inability to concentrate

Causes of Mood Disorders

• Depression is thought to be caused by a combination of – Environmental– Psychological– Biological– genetic factors

• The most enduring theories involve neurotransmitters causing an imbalance that leads to depression.

Types of Mood Disorders

• Major depression. Having less interest in usual activities, feeling sad or hopeless, and other symptoms for at least 2 weeks.

• Dysthymia. This is a chronic, low-grade, depressed, or irritable mood that lasts for at least 2 years.

• Bipolar disorder. This is a condition in which a person has periods of depression alternating with periods of mania or elevated mood.

• Seasonal Affective Disorder (SAD) - have normal mental health throughout most of the year and experience depressive symptoms in the winter or summer.

Treatments for Mood Disorders

• Antidepressants • Psychotherapy – CBT

• Family Therapy

XI. Personality Disorders

A. An enduring pattern of thinking and behavior that deviates markedly from the expectations of the culture of the individual who exhibits it.

B. Typically the pattern of behavior/thinking is seen as appropriate by the individual themselves.

C. 9.1% of the U.S. population (12 month prevelance) D. Sex and race not seen as a factor (although men

tend to be more likely to have antisocial personality disorder)

Symptoms of Personality Disorders

•Symptoms vary based on the specific personality disorder.

Causes of Personality Disorders

- Inherited tendencies – your genes - environment – your life situations

Treatment of Personality Disorders

• There is some debate over the appropriate treatments.

• Two treatments have shown promise for BPD– Dialectical behavior therapy (DBT) – Cognitive therapy

• Still working to develop interventions for other disorders.

The Rorschach Test • AKA the inkblot test• Psychological test in which

subjects' perceptions of inkblots are recorded and then analyzed using psychological interpretation, complex algorithms, or both.

• Some psychologists use this test to examine a person's personality characteristics and emotional functioning.

• The test is named after its creator, Swiss psychologist Hermann Rorschach.

Serial Killers

• Serial murder – unlawful killing of 2 or more by the same person

• What is the psychological diagnosis? – ASPD (only a small percent

are serial killers)– Psychopathic – Sociopathic

• Psychopathy Personal Inventory

Famous Serial Killers in U.S.

• Ted Bundy – rapped and murdered 35 women in 6 states; escaped from prison twice before being executed in 1989.

Famous Serial Killers in U.S.

• Jeffrey Dahmer – Murdered 4 men and 13 young boys. He was known as the Milwaukee, Wisconsin cannibal. He kept heads, skulls and body parts in his apartment

• Killed in prison in 1994

Famous Serial Killers in U.S.

• Donald Henry “Peewee” Gaskins: also known as “The Meanest Man in America”, convicted of nine murders; confessed to more than 200 (not sure how many he actually murdered); executed in 1991.

Famous Serial Killers in U.S.

• Charles Manson - is an American cult leader whose followers carried out several notorious murders in the late 1960s

• Serving life in prison