Psychological DisordersPsychological Disorders

Mental IllnessMental Illness

• Abnormal psychology (“psychopathology”)Abnormal psychology (“psychopathology”)

• DiagnosisDiagnosis o Observing patient’s symptoms and inferring Observing patient’s symptoms and inferring

disorderdisordero Symptoms appear in clusters called Symptoms appear in clusters called

syndromessyndromes

• PrognosisPrognosiso Refers to prediction about the course of Refers to prediction about the course of

identified disorder over timeidentified disorder over time

Mental IllnessMental Illness

• Neurotic disordersNeurotic disorderso Primary symptoms include anxiety or defenses to Primary symptoms include anxiety or defenses to

ward off anxiety (phobias, OCD, PTSD)ward off anxiety (phobias, OCD, PTSD)o Symptoms may cause distress or impair Symptoms may cause distress or impair

functioning but generally allow for social functioning but generally allow for social functioningfunctioning

• Psychotic disordersPsychotic disorderso Includes more severe or “serious” mental disorders Includes more severe or “serious” mental disorders o Thoughts and actions no longer meet the demands Thoughts and actions no longer meet the demands

of reality (schizophrenia, dissociative disorders)of reality (schizophrenia, dissociative disorders)

Mental IllnessMental Illness

• Theoretical models of psychopathologyTheoretical models of psychopathologyo Biomedical/biopsychosocial Biomedical/biopsychosocial

perspectiveperspectiveo Psychodynamic perspectivePsychodynamic perspectiveo Behavioral perspectiveBehavioral perspectiveo Cognitive perspective Cognitive perspective o Systems perspectiveSystems perspective

Biological PerspectiveBiological Perspective

• Emphasizes the physical and biological Emphasizes the physical and biological bases of behaviorbases of behavior

• Examines pathology within the brainExamines pathology within the braino Abnormality stems from disturbances in Abnormality stems from disturbances in

brain activity, neurotransmitter brain activity, neurotransmitter problems, and/or chemical imbalancesproblems, and/or chemical imbalances

• Strongly influenced by neuroscience Strongly influenced by neuroscience o MRI and PET scans re: schizophreniaMRI and PET scans re: schizophrenia

Psychodynamic PerspectivePsychodynamic Perspective

• Abnormal behavior results from:Abnormal behavior results from: a) Unresolved psychological conflicts in early a) Unresolved psychological conflicts in early

childhoodchildhood

b) Conflictb) Conflict between selfish desires of Id and between selfish desires of Id and the demands of the demands of society/personal conscience society/personal conscience of Superegoof Superego

• Emphasizes attacking defense mechanisms Emphasizes attacking defense mechanisms + provoking a catharsis+ provoking a catharsis

Behavioral PerspectiveBehavioral Perspective

• Behaviors learned through conditioning and Behaviors learned through conditioning and society can provide deviant/maladaptive society can provide deviant/maladaptive models that children imitatemodels that children imitate

• Overcoming issues occurs by providing Overcoming issues occurs by providing positive learning experiences, healthy positive learning experiences, healthy models, and rewarding positive behavior models, and rewarding positive behavior

o Note: only some mental disorders neatly fit Note: only some mental disorders neatly fit this model (i.e., Little Albert)this model (i.e., Little Albert)

Cognitive PerspectiveCognitive Perspective

• Abnormal behavior results from Abnormal behavior results from distorted/irrational thinking that leads to distorted/irrational thinking that leads to maladaptive behaviormaladaptive behavior

• Focuses on the role of patient Focuses on the role of patient interpretations and expectations (thoughts) interpretations and expectations (thoughts) in generating/sustaining emotionin generating/sustaining emotion

• Offers useful understanding of depressionOffers useful understanding of depressiono ““Automatic thought process” – depression Automatic thought process” – depression

result of thinking negative/depressing result of thinking negative/depressing thoughts about life’s experiences thoughts about life’s experiences

Systems PerspectiveSystems Perspective

• Looks for the root of an individual’s Looks for the root of an individual’s problem behavior within a broader social problem behavior within a broader social context (i.e., the family)context (i.e., the family)

• Abnormality stems from dysfunctional Abnormality stems from dysfunctional group relations within the familygroup relations within the family

• Focus of counseling treatment becomes the Focus of counseling treatment becomes the family system (not the problem or family system (not the problem or symptomatic family member)symptomatic family member)

Mental IllnessMental Illness

• DSM-IVDSM-IVo Classifies signs and symptoms into syndromesClassifies signs and symptoms into syndromes

• Signs = observable phenomena the patient exhibitsSigns = observable phenomena the patient exhibits• Symptoms = what patients reports to health care Symptoms = what patients reports to health care

professionalprofessional

o Uses a multi-axial/multidimensional approach to Uses a multi-axial/multidimensional approach to diagnose mental illness along 5 dimensionsdiagnose mental illness along 5 dimensions

o Diagnostic classification allows for description, Diagnostic classification allows for description, future course prediction, and treatmentfuture course prediction, and treatment

DSM-IVDSM-IV

Axis I: Clinical SyndromesAxis I: Clinical Syndromes

- Signs and symptoms that cause distress - Signs and symptoms that cause distress (states)(states)

II: Developmental DisordersII: Developmental Disorders

- - Personality/developmental disorders (traits)Personality/developmental disorders (traits)

III: Physical ConditionsIII: Physical Conditions

- - Medical conditions (if any)Medical conditions (if any)

IV: Severity of Psychosocial PressuresIV: Severity of Psychosocial Pressures

- - Psychosocial/environmental problems Psychosocial/environmental problems

V: Highest Level of FunctioningV: Highest Level of Functioning

- - Global assessment of functioningGlobal assessment of functioning

Mood DisordersMood Disorders

• Depression Depression o Psychoanalytic – RPsychoanalytic – Reaction to loss coupled with eaction to loss coupled with

suppressed/stifled suppressed/stifled angeranger

o Behaviorism – Behaviorism – Lack of positive reinforcementLack of positive reinforcemento Cognitive – Cognitive – Negative self-schemas that are global Negative self-schemas that are global

AND AND stable; failures are magnified stable; failures are magnified while successes while successes are minimized are minimized

o Biological – NBiological – Neurotransmitter eurotransmitter deficiencies/chemical deficiencies/chemical imbalances imbalances

Mood DisordersMood Disorders

• Treating depressionTreating depression o Therapy Therapy

o Antidepressants/SSRIs (Paxil, Zoloft, Prozac)Antidepressants/SSRIs (Paxil, Zoloft, Prozac)

o Electro-convulsive/electro-shock therapyElectro-convulsive/electro-shock therapy• Intentional induction of brain seizureIntentional induction of brain seizure• Immediate improvement but can cause Immediate improvement but can cause

memory lossmemory loss• Researchers exploring less traumatic ways to Researchers exploring less traumatic ways to

alter electric alter electric

activity in brain (i.e., Transcranial Magnetic activity in brain (i.e., Transcranial Magnetic Stimulation?)Stimulation?)

Mood DisordersMood Disorders

• Bipolar disorderBipolar disordero ““Manic depressive disorder”Manic depressive disorder”

o Alternating episodes of mania and Alternating episodes of mania and depressiondepression

• Mania = Extreme euphoria, racing thoughts, Mania = Extreme euphoria, racing thoughts, hyperactivity, hyperactivity, little need for sleep little need for sleep

• Low incidence rate Low incidence rate (0.5–1.6%)(0.5–1.6%) but high but high suicide rate suicide rate (10–20%)(10–20%)

o TreatmentTreatment• Mood stabilizers (Lithium, Valproate)Mood stabilizers (Lithium, Valproate)

Anxiety DisordersAnxiety Disorders

• Characterized by intense feelings of Characterized by intense feelings of distress, anxiety, or apprehensiondistress, anxiety, or apprehension

• Anxiety problematic when feelings become Anxiety problematic when feelings become distressing to the point it interferes with distressing to the point it interferes with daily lifedaily life

• Generalized Anxiety Disorder, phobias, Generalized Anxiety Disorder, phobias, Obsessive Compulsive Disorder (OCD)Obsessive Compulsive Disorder (OCD)

Anxiety DisordersAnxiety Disorders

• PhobiasPhobiaso Characterized by intense irrational fear Characterized by intense irrational fear

o Individual often aware the fear is Individual often aware the fear is groundless but will continue to experience groundless but will continue to experience the phobia nonethelessthe phobia nonetheless

o Types of phobiasTypes of phobias• Simple phobia (of a specific object like spiders)Simple phobia (of a specific object like spiders)• Social phobia (fear of public situations)Social phobia (fear of public situations)

o Agoraphobia – fear of being in open places Agoraphobia – fear of being in open places and unable and unable to escape to escape (usually crowds)(usually crowds)

Anxiety DisordersAnxiety Disorders

• Obsessive compulsive disorder (OCD)Obsessive compulsive disorder (OCD) o Extremely persistent obsession Extremely persistent obsession

(unwelcome thoughts) and compulsions (unwelcome thoughts) and compulsions (unwelcome behavior)(unwelcome behavior)

• Several varieties of OCDSeveral varieties of OCD• Arrangers/CleanersArrangers/Cleaners• CountersCounters• CheckersCheckers• Clutterers/HoardersClutterers/Hoarders

Anxiety DisordersAnxiety Disorders

• Treating anxietyTreating anxietyo ““Systematic desensitization”Systematic desensitization”

o Benzodiazepines/tranquilizers (Valium, Benzodiazepines/tranquilizers (Valium, Xanax)Xanax)

• Problems/concerns:Problems/concerns:o DependencyDependencyo Doesn’t necessarily treat underlying anxiety Doesn’t necessarily treat underlying anxiety

issue(s)issue(s)o Many adverse side effectsMany adverse side effectso Strong cross-activity with other depressants Strong cross-activity with other depressants

(alcohol) (alcohol)

SchizophreniaSchizophrenia

• SymptomsSymptomso Disturbances of thought/attentionDisturbances of thought/attentiono Perceptual disturbances (louder noise, more Perceptual disturbances (louder noise, more

intense color)intense color)o Language disturbances (‘word salad’ – “why’s Language disturbances (‘word salad’ – “why’s

Wise wise?”)Wise wise?”)o Loss of attentional focusLoss of attentional focuso Neologism – make up words that sound Neologism – make up words that sound

logical logical (“She is (“She is prastigitious”)prastigitious”)

o Associational chainingAssociational chaining

• Symptoms (con’t)Symptoms (con’t)o Affective disturbances Affective disturbances (flat affect in inappropriate (flat affect in inappropriate

situations)situations)o Withdrawal from reality/complete catatoniaWithdrawal from reality/complete catatoniao Hallucinations (“see the spies coming”, hear Hallucinations (“see the spies coming”, hear

things) things) o Delusions or beliefs inconsistent with realityDelusions or beliefs inconsistent with reality

……of thoughts/influence (others’ brainwaves can of thoughts/influence (others’ brainwaves can influence them)influence them)

……of persecution (convinced people are coming for of persecution (convinced people are coming for them)them)

……of grandeur (false beliefs they are greater than they of grandeur (false beliefs they are greater than they really are)really are)

……of paranoia (high suspicion, constantly being of paranoia (high suspicion, constantly being watched)watched)

SchizophreniaSchizophrenia

• 2 types of onset2 types of onseta) Acutea) Acute

- Patient endures a stressor, followed by - Patient endures a stressor, followed by hallucinationshallucinations

- Better chance for treatment (address the - Better chance for treatment (address the stressor)stressor)

b) Chronicb) Chronic

- Slow, gradual deterioration of the - Slow, gradual deterioration of the individualindividual

- Actual cause unknown and therefore - Actual cause unknown and therefore unclear what unclear what treatment option treatment option is best is best

SchizophreniaSchizophrenia

• Major typesMajor typeso ParanoidParanoido DisorganizedDisorganizedo CatatonicCatatonico Undifferentiated Undifferentiated o ResidualResidual

SchizophreniaSchizophrenia

• CausesCauseso Biological considerationsBiological considerations

• Appears to have a genetic link (i.e., runs in Appears to have a genetic link (i.e., runs in families)families)

• Identical twin = ~50% probabilityIdentical twin = ~50% probability

o Social causesSocial causes• Genetics alone not sufficient cause for Genetics alone not sufficient cause for

schizophreniaschizophrenia• Low SES?Low SES?

SchizophreniaSchizophrenia

• Treatment(?)Treatment(?)o Anti-psychotic medicationsAnti-psychotic medications

• Thorazine – not a perfect drug!Thorazine – not a perfect drug!o Causes dyskinesia Causes dyskinesia o Tolerance issuesTolerance issueso Is “zombification” a cure?Is “zombification” a cure?

• Respiridone?Respiridone?

SchizophreniaSchizophrenia

Dissociative DisordersDissociative Disorders

• Dissociative reactionsDissociative reactionso Characterized by disruptions in consciousness, Characterized by disruptions in consciousness,

memory, or sense of identity (“dissociated”)memory, or sense of identity (“dissociated”)

o Psychogenic amnesia, “fugue”Psychogenic amnesia, “fugue”

• Dissociative Identity DisorderDissociative Identity Disordero ““Multiple Personality DisorderMultiple Personality Disorder””

o At least two separate/distinct personalities exist At least two separate/distinct personalities exist within the same individual within the same individual

Personality DisordersPersonality Disorders

• Antisocial personality disorderAntisocial personality disordero ““Without a conscience”, “sociopath”, Without a conscience”, “sociopath”,

“psychopath”“psychopath”

o Characterized as those who easily exploit Characterized as those who easily exploit or harm others without guilt or remorseor harm others without guilt or remorse

o Slightly more common in men Slightly more common in men (3%) vs. (3%) vs. women (1%)women (1%)

o Violent and non-violent differentiationViolent and non-violent differentiation

• Narcissistic personality disorderNarcissistic personality disordero Extreme preoccupation with the self and Extreme preoccupation with the self and

self-promotionself-promotiono SymptomsSymptoms

• Disregard for the feelings of othersDisregard for the feelings of others• GrandiosityGrandiosity• Obsessive self-interestObsessive self-interest• Pursuit of primarily selfish goals Pursuit of primarily selfish goals • Often demand/expect constant attention Often demand/expect constant attention

and admirationand admiration

Personality DisordersPersonality Disorders

TherapyTherapy

• Psychotherapy/Psychoanalysis (Freud)Psychotherapy/Psychoanalysis (Freud)o Disorders stem from conflicts between Disorders stem from conflicts between

Id, Superego, and EgoId, Superego, and Ego

o Treatment involves communication Treatment involves communication between patient and a therapist, either between patient and a therapist, either individually or in a group individually or in a group

o Make the unconscious conscious Make the unconscious conscious

TherapyTherapy

• HumanisticHumanistico Client-centered therapy (Rogers) Client-centered therapy (Rogers)

• Assumes problems emerge when concept of Assumes problems emerge when concept of self is incongruent with actual experiencesself is incongruent with actual experiences

• Therapist establishes unconditional positive Therapist establishes unconditional positive regard and acceptanceregard and acceptance

• ““Empty chair technique”Empty chair technique”

TherapyTherapy

• Cognitive-behavioralCognitive-behavioral o Thoughts determine behavior, thus Thoughts determine behavior, thus

distorted thinking leads to “maladaptive distorted thinking leads to “maladaptive schemas”schemas”

o Cognitive restructuring and behavior Cognitive restructuring and behavior modificationmodification

• Exposure techniquesExposure techniqueso Systematic desensitization Systematic desensitization o Aversive conditioning Aversive conditioning o FloodingFloodingo ModelingModeling