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Psychological Disorders
PSYCHOLOGYMr. Noble2008-09
A special thanks to my former student teacher--Ms. Sharon Mohr--for her diligent research, insightful professional expertise, and valuable thoughtful effort in compiling much of the information included in this overview of Psychological Disorders.
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Defining Abnormality
Difficult to define…
3 Criteria… Deviance Distress Disability/Maladaptive Behavior
Symptom/Behavior Continuum:_----_________________ normal range__ __________________+++
Abnormal Abnormal
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Ancient Perspective
Perceived Causes movements of sun or moon
lunacy- full moon evil spirits
Ancient Treatments exorcism, caged like animals, beaten, burned,
mutilated, blood replaced with animal’s blood
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Bio-psycho-social Model
assumes that biological, sociocultural, and psychological factors combine and interact to produce psychological disorders
Biological(chemistry, brain)
Psychological( learned helplessness, negative perceptions
and memories)
Sociocultural(Societal expectations, definition of normality
and disorder)
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Medical Model
Diagnosis Label for a set of symptoms
Prognosis Prediction or forecast for the course of a
D/O
Etiology Suspected cause of a disorder
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Classifying Disorders
DSM-IV-TR Diagnostic and Statistical Manual of Mental
Disorders, 4th edition, Text Revision Published by the American Psychiatric Association 2000…(most recent update 2004) Next major revision (DSM-V) anticipated for 2011.
Provides for reliable classification and description of all mental illnessesAllows for better communication
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DSM’s Multi-axial Diagnosis
Axis I Major Clinical Disorders
Axis II Mental Retardation & Personality Disorders
Axis III General Medical Conditions
Axis IV Psychosocial/Environmental Stressors
Axis V Global Assessment of Functioning # between 1 and 100 Current and Highest in past year
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Labeling Issues
Reasons to Label/Diagnose: Needed for communication Guide treatment Insurance reimbursement
Arguments against Labeling: Creates a stigma Creates a self-fulfilling prophecy Fail to see the person behind the disorder
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Major Classes of Disorders
Anxiety DisordersMood DisordersSomatoform DisordersDissociative DisordersSchizophreniaSubstance Use DisordersOther Axis I DisordersPersonality Disorders (Axis II)
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I. Anxiety Disorders
Characterized by generalized apprehension, worry, and a variety of physical symptoms
Generalized Anxiety DisorderPhobiasPanic DisorderObsessive-Compulsive DisorderPost-traumatic Stress Disorder
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Generalized Anxiety Disorder
Experiencing a continuous, generalized feeling of anxiety (reaction to vague or imagined dangers) – 6 months or moreAnxiety in many different areas of lifeAccompanied by physical symptoms…muscle tension, trouble sleeping, irritability, lack of concentration, headaches, fatigue, inability to relax, twitching/trembling, etc.
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Phobias
Specific Phobia Severe anxiety is
focused on a specific object or situation
Examples: Enclosed spaces Snakes Spiders Heights Flying
Social Phobia Fear of embarrassing
oneself in a social situation
Speaking, eating, using bathroom in public
Agoraphobia “fear of the
marketplace” Associated with panic
disorder
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PHOBIAS http://www.phobialist.com/reverse.html
Common and uncommon phobias
Afraid of it Bothers slightly Not at all afraid of it
Beingclosed in,
in a smallplace
Being alone
In a house
at night
Percentageof peoplesurveyed
100
90
80
70
60
50
40
30
20
10
0Snakes Being
in high,exposedplaces
Mice Flyingon an
airplane
Spidersand
insects
Thunderand
lightning
Dogs Drivinga car
Being In a
crowdof people
Cats
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PHOBIAS Treatment
Exposure Treatment
Flooding
Counter-Conditioning
Systematic Desensitization (1) training the patient to physically relax (2) establishing an anxiety hierarchy of the stimuli (3) counter-conditioning relaxation responding to ea. feared stimulus
Biofeedback
Modeling
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Panic Disorder
Frequent Panic Attacks or fear of them: Sudden and unexplainable attacks of
intense fear Come on without warning Not associated with a stimulus Individual fears that he/she is about to die Physical symptoms…choking, tightness in
chest, difficulty breathing, nausea, dizziness Commonly occurs with Agoraphobia
“Nothing is so much to be feared as Fear”
---Henry David Thoreau
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Obsessive-Compulsive Disorder
OBSESSIONS Intrusive and
uncontrollable thoughts
Contamination, safety, etc.
COMPULSIONS Ritualistic and
purposeless actions
Cleaning, washing, checking, etc.
O and C are usually related… compulsions help to decrease the anxiety caused by the obsessionThis pattern begins to interfere with functioning
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OCD
Common Obsessions and Compulsions AmongPeople With Obsessive-Compulsive Disorder
Thought or Behavior Percentage*Reporting Symptom
Obsessions (repetitive thoughts)
Concern with dirt, germs, or toxins 40
Something terrible happening (fire, death, illness) 24
Symmetry order, or exactness 17
Excessive hand washing, bathing, tooth brushing, 85or grooming
Compulsions (repetitive behaviors)
Repeating rituals (in/out of a door, 51up/down from a chair)Checking doors, locks, appliances, 46car brake, homework
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Post-traumatic Stress Disorder
Common among veterans of combat, survivors of accidents and disasters, victims of crimes, etc.
Feel long-lasting after-effects of trauma
Flashbacks, nightmares, insomnia, mood symptoms, stimulus generalization
Symptoms last more than 1 month… up to years later
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II. Mood Disorders
Mental disorders characterized by disturbances of mood that are intense and persistent enough to be maladaptive
Normal range of mood…
Major Depressive Disorder Bipolar Disorder
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Major Depressive Disorder
Clinical depression/Major Depression
Unipolar depression
Single-episode or recurrent episodes
Symptoms must occur for at least 2 weeks
Subtypes: Post-partum onset S.A.D.
Secondary symptoms…
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Depression…symptoms
SSleep disturbance
IInterest GGuilt/worthlessness
EEnergy = fatigue
CConcentration AAppetite disturbance/weight gain/loss
PPsychomotor agitation/retardation
SSuicidal/thoughts of death
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Causes of Depression
Genetic Predisposition + stressful life events
Neurotransmitters Serotonin Norepinephrine
Cognitive Theories Beck & Seligman
Behavioral Theories
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Bipolar Disorder
Previously known as Manic-Depression
Experience both manic and depressive episodes Mania = emotional state characterized by
intense and unrealistic feelings of excitement and euphoria, along with impulsivity
Cycles…not mood swings
High rate of suicide
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Mood Disorders-Bipolar
PET scans show that brain energy consumption rises and falls with emotional swings
Depressed state Manic state Depressed state
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Mood Disorders & Suicide
Not all people who commit suicide are depressed; Not all depressed people commit suicide
Associated with mood disorders, especially bipolar disorder (also schizophrenia)
Warning Signs…
Risk factors…
Prevention…
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Males•Suicide is the eighth leading cause of death for all U.S. men.•Males are four times more likely to die from suicide than females. •Suicide rates are highest among Whites and second highest among American Indian and Native Alaskan men. •Of the 24,672 suicide deaths reported among men in 2001, 60% involved the use of a firearm.Females•Women report attempting suicide during their lifetime about three times as often as men.
SUICIDE: Male v. Female
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•Overall rate of suicide among youth has declined slowly since ‘92.
•However, rates remain unacceptably high.
•Adolescents and young adults often experience stress, confusion, and depression from situations occurring in their families, schools, and communities.
•Such feelings can overwhelm young people and lead them to consider suicide as a “solution.”
•Few schools and communities have suicide prevention plans that include screening, referral & crisis intervention programs for youth.
SUICIDE: Youth
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•Suicide is the third leading cause of death among young people ages 15 to 24.
•Of the total number of suicides among ages 15 to 24 in 2001, 86% were male and 14% were female.
•American Indian and Alaskan Natives have the highest rate of suicide in the 15 to 24 age group.
•In 2001, firearms were used in 54% of youth suicides.
SUICIDE: Youth
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•Previous suicide attempt(s) •History of mental disorders, particularly depression •History of alcohol and substance abuse •Family history of suicide •Family history of child maltreatment •Feelings of hopelessness •Impulsive or aggressive tendencies •Barriers to accessing mental health treatment
SUICIDE: Risk FactorsThe first step in preventing suicide is to identify and understand the risk factors.
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•Loss (relational, social, work or financial) •Physical illness •Easy access to lethal methods •Unwillingness to seek help due to stigma•Local epidemics of suicide •Isolation - feeling cut off from other people
The first step in preventing suicide is to identify and understand the risk factors.
SUICIDE: Risk Factors
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•Effective clinical care•Easy access to clinical interventions & support•Family and community support •Medical & mental health care relationships•Problem solving, conflict resolution skills•Cultural & religious beliefs/support
SUICIDE: Protective FactorsProtective factors buffer people from the risks associated with suicide. A number of protective factors have been identified:
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III. Somatoform Disorders
Also know as Hysteria (Freud)
Conditions involving physical complaints or disabilities that occur without physical pathology
NOT psychosomatic disorders…
Conversion Disorder Hypochondriasis
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Conversion Disorder
Conversion of emotional difficulties into the persistent loss of a physiological function
Paralysis, loss of feeling, exceptional sensitivity, mutism, blindness, deafness
Not faking a physical problem
Cannot be explained physically
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Hypochondriasis & Somatization Disorders
HypochondriasisPreoccupation with fear that he/she has a serious disease Based on the misinterpretation of bodily symptomsMountain out of a molehillNo evidence of illness
Somatization DisorderHistory of diverse physical complaints of all varieties (all body systems)
Focus on numerous symptoms
Many trips to doctor, many medications, no root cause found
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IV. Dissociative Disorders
Dissociation…the human mind’s capacity to mediate complex mental activity in channels split off from or independent of conscious awareness
A way of managing anxiety and stress…Psychogenic/Dissociative Amnesia & Fugue
Dissociative Identity Disorder
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Amnesia & Fugue
PSYCHOGENIC AMNESIA Inability to recall
certain personal information, which is still know at the unconscious level
Loss in episodic memory, not procedural or semantic
PSYCHOGENIC FUGUE Loss of memory
accompanied by an actual flight from one’s present life situation to a new environment
May take on a new identity
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Dissociative Identity Disorder
Previously known as Multiple Personality Disorder
Individual manifests at least two or more distinct systems of identityHost personality + Alter identities (15)Associated with childhood abuseRare disorder; Popular in mediaCan be faked or influenced by therapist
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V. Schizophrenia
Characterized by confused and disordered thoughts and perceptionsMost debilitating of the mental disorders; Deterioration of adaptive behaviorSubtypes: Paranoid Disorganized Catatonic Undifferentiated
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Schizophrenia…symptoms
BBizarre behaviors (catatonia, others)
AAffect (inappropriate, flat)
DDelusions
SSpeech (disorganized, incoherent)
HHallucinations
IInability to care for self or function
NNegative symptoms
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Positive vs. Negative Sx
POSITIVE SYMPTOMS Presence of something abnormal Examples:
NEGATIVE SYMPTOMS Absence of something normal Examples:
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Schizophrenia…
DELUSIONS False beliefs maintained in the face of contrary
evidence Types: Grandeur Identity
Persecution Reference
HALLUCINATIONS Sensations in the absence of external stimuli Types: visual, auditory, tactile, olfactory,
gustatory
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Causes of Schizophrenia
Genetic Predisposition Twin study evidence
Neurotransmitters Dopamine hypothesis
Brain Structure & Function
Family & Interactions Double-bind theory Schizophrenogenic mother
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VI. Substance Use Disorders
Substance AbuseSubstance Dependence Psychological dependence + Addiction Alcoholism = Alcohol Dependence
Important terms… Tolerance Withdrawal
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VII. Other Axis I Disorders
Eating DisordersSleep DisordersDisorders of childhood and adolescence Autism, ADHD, Tourette’s, Conduct Disorder
Sexual and Gender Identity DisordersCognitive DisordersImpulse Control DisordersAdjustment Disorders
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VIII. Personality Disorders
Diagnosed on Axis IIStem from the gradual development of inflexible and distorted personality and behavioral patterns that result in persistently maladaptive ways of relating to the world
Ego-syntonic…not a problem for the person A problem for others
Resistant to treatment (only behavioral)
FOCUS Antisocial, Narcissistic, OCPD
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OCPD symptoms tend to appear early in adulthood and are defined by inflexibility, close adherence to rules, anxiety when rules are transgressed, and unrealistic perfectionism. A person with obsessive compulsive personality disorder exhibits several of the following symptoms:
•abnormal preoccupation with lists, rules, and minor details
•excessive devotion to work, to the detriment of social and family activities
•miserliness or a lack of generosity
•perfectionism that interferes with task completion, as performance is never good enough
•refusal to throw anything away (pack-rat mentality)
•rigid and inflexible attitude towards morals or ethical code
•unwilling to let others perform tasks, fearing the loss of responsibility
•upset and off-balance when rules or routines disrupted.
Symptoms of Obsessive Compulsive Personality
Disorder
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Psychopathology & The Law
Competence to Stand Trial Can individual participate in own defense at
time of trial?
Involuntary Civil Commitment Should individual be hospitalized against their
will due to imminent danger? Suicidal or homicidal Decided by doctor, then court; need evidence
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More Legal Issues…State-level
Insanity Plea Should individual not be held accountable due
to their mental state at the time of the crime? Could not determine right from wrong
Determined by judge before actual trial Difficult to prove, but prevalent in media Sent for treatment, then released
*Insanity is a LEGAL term…!
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More Legal Issues…State-level
Guilty but Mentally Ill Alternative to insanity plea in some states Adopted by Pennsylvania… 1st trial determines guilt or innocence 2nd trial determines sanity or insanity Sent for treatment, then to prison to complete
sentence…get treatment as well as punishment
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•Cognitive therapy identifies habitual ways in which patients distort information (e.g. automatic thoughts) and teaches patients to identify, evaluate, and respond to their dysfunctional thoughts and beliefs, using a variety of techniques to change thinking, mood, and behavior. Cognitive therapy is a structured, goal oriented, problem focused, and time limited intervention.
TYPES OF PSYCHOTHERAPY — A number of types of psychotherapy are used to treat psychological disorders:
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•Behavioral therapy attempts to alter behavior by systematically changing the environment that produces the behavior. Behavioral changes are believed to lead to changes in thoughts and emotions.
•Exposure-based behavioral treatments utilize gradual, systematic, repeated exposure to the feared object or situation to allow patients with anxiety disorders to become desensitized to the feared stimulus.
TYPES OF PSYCHOTHERAPY
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•Cognitive Behavioral therapy (CBT) combines principles of both behavioral and cognitive therapy, focusing simultaneously on the environment, behavior, and cognition. Cognitive behavioral therapy is also structured, goal directed, problem focused. Patients learn how their thoughts contribute to symptoms of their disorder and how to change these thoughts. Increased cognitive awareness is combined with specific behavioral techniques.
TYPES OF PSYCHOTHERAPY
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•Problem Solving therapy, a short-term, cognitive behavioral intervention, teaches a systematic method for solving current and future problems. Patients acquire new skills for successfully resolving interpersonal difficulties. These skills include the following sequential steps: 1) Problem definition; 2) Goal setting; 3) Generating, choosing, and implementing solutions; and 4) Evaluating outcomes.
TYPES OF PSYCHOTHERAPY
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•Interpersonal therapy addresses issues such as grief, role transitions, interpersonal role disputes, and interpersonal deficits as they relate to the patient's current symptoms.
•Family therapy attempts to correct distorted communications and relationships as a means of helping the entire family, including the identified patient. In patients with serious mental illness, such as schizophrenia, family therapy helps family members learn about the disorder, solve problems, and cope more constructively with the patient's illness.
TYPES OF PSYCHOTHERAPY
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•Psychoeducation provides patients with information about their diagnosis, its treatment, how to recognize signs of relapse, relapse prevention, and strategies to cope with the reality of prolonged emotional or behavioral difficulties.
•The goal of psychoeducation is to reduce distress, confusion, and anxiety within the patient and/or the patient's family to facilitate treatment compliance and reduce the risk of relapse.
•Psychoeducation is often particularly helpful for patients and the families of patients with chronic, severe psychiatric disorders such as schizophrenia and bipolar disorder.
TYPES OF PSYCHOTHERAPY