psychological disorders copyright 1998 allyn & bacon

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  • Slide 1
  • PSYCHOLOGICAL DISORDERS Copyright 1998 Allyn & Bacon
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  • What Is Normal and Abnormal? A man kissing another man A woman slapping a child A man driving a nail through his hand A woman refusing to eat for several days A man barking like a dog
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  • Perspectives on Causes and Treatment of Disorders u Biological Perspective u Psychodynamic Perspective u Learning Perspective u Cognitive Perspective u Humanistic Perspective Copyright 1998 Allyn & Bacon
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  • What is Abnormal? u Textbook: 3 Ds u Distressing u Dysfunctional u Deviance
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  • Abnormal Behavior
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  • Schizophrenia u Based on observation and self report u Signs and Symptoms u Abnormal content of thought u Illogical form of thought u Distorted perception u Changed affect u Impaired sense of self u Impaired interpersonal functioning
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  • Onset Timing Period of greatest susceptibility 1020304050 AGE
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  • Distinguishing features u flat, dull, inappropriate mood, blank stare u confused thinking, rambling train of thought u detachment, absorption in private world u severely reduced motivation, indecision
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  • Positive Symptoms of Schizophrenia u Hallucinations u Delusions u Disturbances in Form of Thought or Speech u Grossly Disorganized Behavior u Inappropriate Affect Copyright 1998 Allyn & Bacon
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  • Negative Symptoms of Schizophrenia u Social Withdrawal u Apathy u Loss of Motivation u Lack of Goal- Directed Activity u Very Limited Speech u Slowed Movements u Poor Hygiene and Grooming Copyright 1998 Allyn & Bacon
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  • Types of Schizophrenia u Catatonic u Disorganized u Paranoid u Undifferentiated Copyright 1998 Allyn & Bacon
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  • Causes of Schizophrenia u Genetic Inheritance u Excessive Dopamine Activity Copyright 1998 Allyn & Bacon
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  • Ventricle Example Cortex Cross-Sections NormalSchizophrenic
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  • Genetics? u 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).
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  • Types of Schizophrenia u Type I u positive symptoms u sudden onset u responds to antipsychotic meds rapidly u Type II u negative symptoms u poor response to antipsychotic meds u brain atrophy???
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  • Phases of Schizophrenia u Acute Episode u Rapid deterioration, weeks or months u 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...........
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  • 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).
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  • Prodromal.... Z clear deterioration not due to substances u Typical symptoms u marked social isolation or withdrawal u impairment in role functioning u markedly peculiar behavior u digressive, vague or poverty of speech u odd beliefs or thinking u unusual perceptual experiences
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  • u Residual Phase u Psychotic features may be absent u Sense of apathy u Difficulties in thinking, language u Harboring unusual ideas
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  • Subtypes of Schizophrenia u Catatonic : rigid posturing, stupor u Disorganized : silly, giddy, emotional u Paranoid : Delusions of persecution, often anger u Undifferentiated type : multiple u Residual type : Previous episodes, currently not psychotic, mild signs
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  • Other Psychosis X Schizophreniform Disorder : same symptoms, 1 - 6 months X Schizoafftective Disorder : hallucinations, delusions plus mood disturbances X Delusional Disorder X Brief Psychotic Episode X Substance Induced Psychotic Disorder X Psychotic Disorder due to....(specific medical condition)
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  • Treatment u Childers (1964) concludes that the combination of ECT and drug increases the percentage of patients who attain a moderate or better improvement. u Core positive symptoms (e.g., hallucinations, delusions, thought disorder) appear to be significantly reduced by benzodiazepines in some but not all studies. u Based on limited data, Plasky (1991) found little evidence of any efficacy of tricyclic antidepressants for the negative symptoms of schizophrenia
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  • ECT treatment u Erwin and Thompson (1978) believe that ECT does not treat the schizophrenic process but rather treats secondary mood disorders in schizophrenia u Patients with schizoaffective disorder and catatonia had the best response rate (85% and 82%, respectively) to ECT.
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  • Talk Therapies u Psychotherapy goals are around management of disorder rather than cure. u Family therapy is vital to assist in coping. u Deal with related emotions....anxiety, depression, frustration, anger
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  • Mood Disorders u Major Depressive Disorder u Seasonal Depression u Bipolar Disorder Copyright 1998 Allyn & Bacon
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  • Major Depressive Disorder u Overwhelming feelings of sadness, despair, hopelessness u Loss of interest in pleasurable activities
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  • Common Symptoms u Mood swings u Tearfulness u Irritability u Apathy u Loss of energy u Concentration/attention problems u Indecision u Pervasive mood of sadness
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  • Symptoms..... u Negativity and pessimism u Guilt, self-reproach u Psychomotor retardation or agitation u Changes in appetite, weight u Sleep difficulties u Thoughts of death or suicide u Withdrawal u Feelings of hopelessness
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  • Variations in Depression u Reactive u Endogenous, chronic u Drug induced u Medically related (surgery, postpartum) u Bereavement u Agitated depression u Seasonal Affective Disorder
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  • Dual Diagnosis u Substance abuse and psychological disorder u Depression common u Schools of thought u alcohol causes depression (depressant) u depression leads to use of alcohol
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  • u When depression goes untreated, its most tragic cost is suicide. Fifteen percent of people in whom depression is overlooked, untreated, or improperly treated, will commit suicide. This means about 20,000 lives each year, in North America alone. Depression and Suicide
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  • Treatment there are two very effective treatments for depression-- medication and psychotherapy u almost 80% of people with depression improve with these treatments u depression becomes more difficult to treat the longer its symptoms go untreated u without proper treatment, 10 to 15% of people who suffer depression commit suicide.
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  • St Johns Wort There is considerable public interest in claims that extracts from the herb Hypericum perforatum, commonly known as St. Johns wort, may be an effective treatment for depression. Although St. Johns wort is widely prescribed in Europe, clinical research in the USA is incomplete. There is considerable public interest in claims that extracts from the herb Hypericum perforatum, commonly known as St. Johns wort, may be an effective treatment for depression. Although St. Johns wort is widely prescribed in Europe, clinical research in the USA is incomplete.
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  • Gender & Depression (Data from Kessler, et al., 1994)
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  • Prognosis (1 year) (APA Data, 1994)
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  • Seasonal Affective Disorder u A greater than normal mood fluctuation with the seasons u Related to amount & intensity of light
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  • Seasonal Affective Disorder (After Wurtman & Wurtman,1989)
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  • Bipolar Disorder u Manic episodes & extreme depression mixed with normal affect u Mania involves delusional levels of optimism, euphoria, & energy u Equally common in both sexes u Sufferers make poor decisions while manic, withdraw when depressed
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  • Bipolar Disorder (Data from Kessler, et al., 1994)
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  • Genetic Connection u Moderate in major depressive disorder u Strong in bipolar depression
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  • Causes & Treatments u Depression: low norepinephrine & serotonin levels u Mania: high norepinephrine levels u Major Depressive Disorder: serotonin selective reuptake inhibitors (e.g. Prozac)
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  • Causes & Treatments u Bipolar Depression: lithium carbonate u Neurotransmitter levels

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