Download - 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


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


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


Types of SchizophreniaTypes of Schizophrenia

Catatonic Disorganized Paranoid Undifferentiated


Causes of SchizophreniaCauses of Schizophrenia

Genetic Inheritance Excessive Dopamine Activity


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


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


Anxiety DisordersAnxiety Disorders

Generalized Anxiety Disorder Panic Disorder Phobias Obsessive-Compulsive Disorder


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


Compulsions: intrusive, inappropriate actions that often prevent obsessions


Obsessions

Anxiety

Compulsions

Reduce

Somatoform DisordersSomatoform Disorders

HypochondriasisConversion Disorder


Dissociative DisordersDissociative Disorders

Dissociative Amnesia Dissociative Fugue Dissociative Identity Disorder


Other Psychological DisordersOther Psychological Disorders

Sexual and Gender Identity Disorders

Personality Disorders


Download - PSYCHOLOGICAL DISORDERS Copyright 1998 Allyn & Bacon

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