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© Kip Smith, 2003
Mental Disorders
© Kip Smith, 2003
Topics
Categories of mental disorders Neuroses Psychoses
Neuroses
Psychoses
Diagnosis using the DSM
© Kip Smith, 2003
Mental distress ≠ mental disorder
Just because you are bummed out doesn’t mean you are mentally ill
For example, sadness, pessimism and low self-esteem are all parts of normal mental life, as long as they
Do not persist Do not have a biological origin Are essentially voluntary
E.g., you know WHY you are temporarily bummed
© Kip Smith, 2003
Mental disorders
Neurosis Distressed but still rational and social
Psychosis Loss of contact with reality, irrational ideas &
distorted perception
© Kip Smith, 2003
Criteria for considering behavior to be a Disorder
The behavior must be Unjustifiable & Maladaptive & Atypical & Disturbing ==
Distressing
Distressing behavior may be rational or not
If behavior is NOT in the person’s best interest, then the behavior suggests some form of psychosis
© Kip Smith, 2003
Rationality
Acting in a manner that you know is in your own best interest = will help you achieve your goal
Neurotics are rational but distressed
Psychotics are NOT rational
© Kip Smith, 2003
Examples of Neuroses
Anorexia - bulimia Anxiety
Obsessive - compulsive Post trauma stress Phobia
Mood disorders Depression Mania Bipolar syndrome
Personality disorders Anti-social Histrionia Narcissism
Sexual dysfunction Substance abuse
Sometimes it is hard to tell when a behavior
crosses the line
from neurosis to psychosis
© Kip Smith, 2003
Anorexia - bulimia
Anorexia nervosa is a life-threatening eating disorder defined by a refusal to maintain body weight within 15 % of an individual's minimal normal weight. Other essential features of this disorder include an intense fear of gaining weight, a distorted body image, and amenorrhea (absence of at least three consecutive menstrual cycles when otherwise expected to occur) in women. Sometimes people starve and binge-purge, depending on the extent of weight loss. This can be physically very dangerous. People who present an on-going preoccupation with food and weight even at lesser weight reductions would benefit from exploring their cognitive and relationship skills.
http://www.nami.org/helpline/anorexia.htm
© Kip Smith, 2003
If you know someone with anorexia - Force her to confront it
http://www.anred.com
http://www.altrue.net/site/anadweb/
© Kip Smith, 2003
Anxiety (Neurosis)
Continually tense, apprehensive; persistent autonomic (sympathetic) arousal
Obsessive-compulsive Anxiety with unwanted
repetitive thoughts and/or actions
High need for perfection and order
Phobia Persistent irrational fear
Panic Post-traumatic stress
© Kip Smith, 2003
Obsession
Recurrent and persistent thoughts, impulses, or images that are experienced, at some time during the disturbance, as intrusive and inappropriate and that cause marked anxiety or distress
The thoughts, impulses, or images are not simply excessive worries about real-life problems
The person attempts to ignore or suppress the thoughts, impulses, or images, or to neutralize them with some other thought or action
The person recognizes that the obsessional thoughts, impulses, or images are a product of his or her own mind (not imposed from without as in thought insertion)
© Kip Smith, 2003
Compulsion
Repetitive behaviors (e.g., hand washing, ordering, checking) or mental acts (e.g., praying, counting, repeating words silently) that the person feels driven to perform in response to an obsession, or according to rules that must be applied rigidly
The behaviors or mental acts are aimed at preventing or reducing distress or preventing some dreaded event or situation; however, these behaviors or mental acts either are not connected in a realistic way with what they are designed to neutralize or prevent or are clearly excessive
http://www.narsad.org/bd/ocp.html
© Kip Smith, 2003
Obsessive-Compulsive disorder
At some point during the course of the disorder, the person has recognized that the obsessions or compulsions are excessive or unreasonable.
Note: This does not apply to children.
The obsessions or compulsions cause marked distress, are time consuming (take more than one hour a day), or significantly interfere with the person's normal routine, occupational (or academic) functioning, or usual social activities or relationships.
Reprinted from the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. Copyright 1994 American Psychiatric Association.
© Kip Smith, 2003
Mood Disorders (Neurosis)
Depression, Feelings of:
worthlessness low self-esteem pessimism low motivation generalization of
negative attitudes psychomotor
dysfunction More women than men
(report) being depressed 2: 1
Mania Euphoria Inflated self-esteem Grandiosity Fragmented attention
Bipolar Mood swings between
the hopelessness of depression and the euphoria of mania
(manic depression)
© Kip Smith, 2003
Depression
http://www.narsad.org/bd/dep.html
Depression isn't just a brief blue mood or a passing sadness that lifts in a few hours or even a few days. People who have depression -- or, in more formal clinical terms, major depressive disorder -- experience at least five of the following symptoms, which must include the first or second, nearly every day, all day, for at least two weeks:
© Kip Smith, 2003
Symptoms of depression, 1
Persistent depressed mood, including feelings of sadness or emptiness
Loss of interest or pleasure in activities or hobbies that were once enjoyed, including sex
Feelings of hopelessness and pessimism
Feelings of guilt, worthlessness, and helplessness
Insomnia, early-morning awakening, or oversleeping
Loss of appetite accompanied by weight loss or overeating accompanied by weight gain
© Kip Smith, 2003
Symptoms of depression, 2
Decreased energy, fatigue, and feeling "slowed down"
Restlessness and irritability
Difficulty concentrating, remembering, and making decisions
Thoughts of suicide or death (not just fear of dying) or suicide attempts
Persistent physical symptoms, such as headaches, digestive disorders, or chronic pain, that do not respond to medical treatment and for which no physical cause can be found
© Kip Smith, 2003
Mania
A manic episode is characterized by a distinct period of a mood change that is either elevated (to the point of elation), expansive, or irritable.
During this phase, which may last from several days through several months, the patient's behavior causes difficulties in both professional and social activities.
http://www.narsad.org/bd/bip.html
© Kip Smith, 2003
Symptoms of mania
Decreased need for sleep
Increased pressure of speech
Distractibility
Irritability
Inflated self-esteem or grandiosity
Excessive involvement in activities that have a high risk for pain consequences that are not recognized
© Kip Smith, 2003
Bipolar syndrome
Behavior oscillates between depression and mania
Used to be called manic depression
© Kip Smith, 2003
Bipolar manic episodes
Frequently, those experiencing a manic episode do not realize they are affected and will therefore resist any medical treatment attempt.
Close friends will recognize the mood and behavior patterns as being excessive, while the casual observer may not see anything disturbing.
The patient may become frankly psychotic with delusions and hallucinations.
© Kip Smith, 2003
Bipolar depressed episodes
A depressive phase usually lasts two weeks to many months, during which the time the patient will experience a lack of interest or pleasure in all activities.
Patients may describe themselves as feeling sad or blue, devoid of motivation, or worthless. These feelings and thoughts may or may not be stated openly in front of others.
© Kip Smith, 2003
Bipolar depressed episodes
The course of a depressive episode may vary from person to person. Symptoms may develop over a period of days or weeks, or they may occur suddenly, without warning. Sudden onset of this condition can be caused by external factors, including stress, death of a family member, or divorce. Duration of an episode will vary and depends on medical treatment employed.
http://www.narsad.org/bd/bip.htm
© Kip Smith, 2003
Personality Disorders (Neurosis)
Inflexible and enduring patterns of behavior that impair social functioning
Relatively untreatable Patients do not think
anything is wrong & resist treatment
Histrionic Display shallow,
attention-getting emotions, sexual aggression
Narcissistic Exaggerated self-image
(aided by fantasies) Anti-Social
Complete disregard for others’ rights
Lack of a conscience for wrong-doing
© Kip Smith, 2003
Psychosis Alzheimer’s
Schizophrenia
DissociationAmnesiaFugueIdentity disorder
© Kip Smith, 2003
Poster Boy for Psychosis
Ted Kaczynski, ex-professor of math, lived alone in a shack, rarely bathed, sent bombs to strangers
© Kip Smith, 2003
Schizophrenia
Schizophrenia is classified in people who exhibit the following traits:
Characteristic symptoms Social/occupational dysfunction Duration > 6 months No mood disorders (depression, mania, mixed) Not due to drug use Not due to developmental disorder (autism)
© Kip Smith, 2003
Symptoms of schizophrenia
Two (or more) of the following, each present for a significant portion of time during a 1-month period (or less if successfully treated):
1. delusions
2. hallucinations
3. disorganized speech (e.g., frequent derailment or incoherence)
4 grossly disorganized or catatonic behavior
5. negative symptoms, i.e., affective flattening, alogia, or avolition
© Kip Smith, 2003
Positive and negative symptoms
Positive symptoms Disorganized, delusional
thinking Distorted perception, Inappropriate emotions
and actions Bizarre behavior
± Paranoia Pervasive distrust and
suspicion of others ± Catatonia
Negative symptoms No interest in other
people or social relationships
Detached from social relationships
Emotionally cold with flat affect
Pervasive interpersonal deficits
Poverty of speech Apathetic attention
© Kip Smith, 2003
Social dysfunction
For a significant portion of time since the onset of the disturbance, one or more major areas of functioning such as work, interpersonal relations, or self-care are markedly below the level achieved prior to the onset (or when the onset is in childhood or adolescence, failure to achieve expected level of interpersonal, academic, or occupational achievement).
http://www.narsad.org/bd/sch.html
© Kip Smith, 2003
Psychopharmacology of Schizophrenia
Too much dopamine in the frontal lobe
The mind runs amok
© Kip Smith, 2003
Dissociative Disorders(Psychoses)
A disruption in the usually integrated functions of consciousness, memory, identity or perception
Amnesia Fail to recall events
Fugue Fail to recall past & Run away & Assume new identity
Identity Disorder Multiple personalities Most rare, usually faked
© Kip Smith, 2003
Diagnosing neuroses and psychoses
© Kip Smith, 2003
Diagnostic and Statistical Manual of Mental Disorders
DSM 4th edition Provides a multidimensional approach to
diagnosing disorders diagnostic criteria prevalence data case illustrations
Uses decision trees to guide diagnoses
© Kip Smith, 2003
The dimensions are NOT mutually exclusive
DSM’s 5 Dimensions of Disorder
1 Clinical symptoms 2 Personality disorders 3 General medical conditions 4 Psychosocial & environmental problems 5 Global assessment of functioning
© Kip Smith, 2003
1 Clinical symptoms
Anxiety Depression Schizophrenia Substance abuse
Includes alcohol
Disorders Sleep Sexual Eating
© Kip Smith, 2003
2 Personality Disorders
Obsessive-compulsive Dependent personality
Passively allows others to make decisions Antisocial personality
© Kip Smith, 2003
3 General Medical Conditions
Any medical conditions relevant to understanding or treatment
Organic brain damage Diabetes HIV
© Kip Smith, 2003
4 Psychosocial, Environmental Problems
Social support structure Death of a loved one Discrimination Economic or legal problems
© Kip Smith, 2003
5 Global Assessment of Functioning
Current occupational functioning Highest level of functioning in the past
year
© Kip Smith, 2003
Periods of mild mania and mild depression
Due to a medical condition
Due to drug, meds, or toxins
Periods of mania and at least one
period of depression
Periods of depression with psychosis
(delusions or hallucinations)when not depressed
IfNO
Mood disorder due to a med. cond.
Substance-induced mood disorder
Bipolar disorder, Type 1
Bipolar disorder, Type 2
Schizophrenia
Depression
Sample DSM Decision Tree for a Patient with Depressed Mood
If YES
© Kip Smith, 2003
Models of Psychological Disorders
Medical model Disorders are diseases
Disorders can be diagnosed on the basis of their symptoms
Disorders can be treated and, often, cured
Diathesis-Stress Model Biological predisposition
+ Stress -> disorder
“Humpty dumpty had a thin shell.
Didn’t break until he fell.”