Introduction to Psychology, 7th Edition, James W. Kalat Chapter 16: Specific Disorders and...

Introduction to Psychology, 7th Edition, James W. KalatChapter 16: Specific Disorders and Treatments

Chapter 16

Specific Disorders and Treatments


Progress in Abnormal Psychology

The growth of understanding of mental disorders and their treatment has paralleled the progress of medical science.

Although we have much yet to learn, we now can make accurate distinctions between a wide range of disorders and we can tailor treatments to meet the needs of those suffering from specific disorders.


Module 16.1

Anxiety and Avoidance Disorders


Disorders Characterized by Excessive Anxiety

Anxiety refers to a certain amount of fear and caution in the face of potential hazards. A certain amount of anxiety is normal. Anxiety is considered pathological when it interferes with

daily functioning.



Generalized anxiety disorder Generalized anxiety disorder (GAD) is the experience

of almost constant and exaggerated worry. There is no basis for the worries but the person is

tense, irritable and tired. About 5% of the general population will experience

GAD. Often it is co-diagnosed with other mood disorders

such as depression.



Panic disorder Panic disorder (PD) is characterized by frequent

periods of anxiety and occasional attacks of panic. Panic attacks involve rapid breathing, increased heart

rate, chest pains, sweating, trembling and faintness. Panic attacks usually last just a few minutes, but can

be much longer.



Panic disorder Panic disorder is experienced by 1-3% of adults and

occurs in many cultures. More women than men are diagnosed with Panic

Disorder. Hyperventilation, or rapid deep breathing, is a key

symptom.



Panic disorder Hyperventilation causes the body to react as if

suffocation were occurring. The person’s subjective interpretation of the symptoms

of hyperventilation can cause an increase in panic or a calming down.

People with panic disorder tend to interpret these episodes as uncontrollable and life threatening.

The constant anxiety they experience increases the likelihood of further panic attacks.



Panic disorder Treatments for panic disorder include:

Psychotherapy Anti-depressant drugs Advice: “Don’t worry about panic attacks; they won’t

kill you.”



Panic disorder Common co-existing disorders include:

Social phobia – severe avoidance of other people and fear of doing anything in public.

Agoraphobia – an intense fear of open or public places.



Phobias Avoidance behaviors are highly resistant to extinction. Phobia is the most common type disorder involving

avoidance behaviors. A phobia is strong and persistent fear of a specific object

or situation – so strong it interferes with daily living.



Phobias The Prevalence of Phobias

Not all extreme fears qualify as phobias. About 11% of U.S. adults suffer from a phobia at

some point in their lives. About 5-6% are experiencing a phobia at any given

time. Phobia usually does not persist across the lifetime –

many young adults lose them by middle age.


Figure 16.2 Most phobias do not last a lifetime. Young people with phobias often lose them by middle age.


Disorders Characterized by Excessive Avoidance

Phobias Acquiring a phobia:

Some fears are innate but many are learned. Some phobias can be traced to a specific event. The early behaviorists were the first to demonstrate

how fears might be learned. This does not account for the fact that some phobias

are much more common and easily acquired than others.



Phobias The most common phobias include:

Open spaces Closed spaces Heights Lightening and thunder Certain animals – (snakes, spiders, dogs) Illnesses/germs


Figure 16.4 A lab-reared monkey learns to fear snakes from the reactions of a wild-reared monkey. But if the snake is not visible, the lab-reared monkey fails to learn any fear.







Phobias Behavior therapy for phobias

Systematic desensitization – reduces fear by gradually exposing people to the object under controlled conditions. Virtual reality is now being employed for this kind of therapy.

Flooding or implosion – a sudden and large-scale exposure to the object under controlled conditions.



Phobias Drug therapies for phobias and anxieties

Benzodiazepines, a common type of tranquilizer, are often prescribed for anxiety disorders.

They suppress symptoms only temporarily and can be addictive.

Anti-depressants, which are not likely to be taken habitually, are used more effectively.



Obsessive-compulsive disorder There are two distressing symptoms that comprise

obsessive-compulsive disorder. Obsessions are repetitive, unwelcome streams of

thought. Compulsions are repetitive, almost irresistible

actions. Obsessive thoughts generally lead to compulsive

actions. Checking and cleaning are two very common

compulsive behaviors.



Obsessive-compulsive disorder Therapies for obsessive-compulsive disorder:

Exposure therapy is very similar to systematic desensitization.

The patient is exposed to the situation that brings on the compulsive behavior, but is prevented from engaging in it.

The most common drug treatments for this disorder utilize clomipramine and other serotonin reuptake inhibiters.


Anxieties and Avoidance

Phobias and anxiety disorders involve the interaction and influence of cognition and emotion upon each other.

People who suffer from these conditions are aware that their reactions are exaggerated, but this awareness doesn’t cure the problem.

These disorders are challenging but psychologists continue to improve the efficacy of available treatments.


Module 16.2

Substance-Related Disorders


Substance Dependence (Addiction)

Individuals who find it difficult or impossible to quit a dangerous habit are said to have an addiction to it or a dependence on it.

People vary widely in how this affects their daily lives and functioning.



Nearly all addictive drugs stimulate the dopamine receptors in the nucleus accumbens.

Activation of these synapses causes increased attention. This activation is accompanied by feelings of great

pleasure.



There are two symptoms involved in the development of a drug addiction. Tolerance – decreased effects of a given dose. Withdrawal – unpleasant sensations when the drug is

not used (or too little is used given the development of tolerance).

Activities and substances that are not drugs can produce addictions – suggesting that addiction is a function of the person, not the drug alone.



Is substance dependence a disease? It depends in part on how we define “disease.” Psychologists currently favor the use of continuum from

“no addiction” to “severe addiction.”



Nicotine dependence Cigarette smoking is based on nicotine addiction. People are generally able to quit smoking more easily if

they have a replacement source of nicotine (i.e. a patch). Low-nicotine/low-tar cigarettes do not help people to

quit.


Figure 16.7 “Low-nicotine” cigarettes have a row of small holes in the filter; room air is supposed to enter through those holes when the smoker inhales and therefore dilute the tobacco smoke. If people smoke such cigarettes without covering the air holes, little tar and nicotine pass through the cigarette, as we see from the relatively clean filter tip. However, if people cover the holes with their fingers or tape, they will receive about as much tar and nicotine as they would from any other filtered cigarette.



Alcoholism Alcoholism is defined as the habitual overuse of alcohol. Treatment of chronic alcoholism is very difficult. In order for treatment of alcoholism to be effective, we

need to detect the problem in its early stages. We need to identify the factors that put certain people at

risk.



Alcoholism Type I alcoholism develops gradually over the lifespan. It is equally prevalent in men and women. It is generally less severe in its health consequences. Type II alcoholism has an early onset. It is much more prevalent in men and more severe.


Table 16.3 Type I and Type II alcoholism



Alcoholism: Risk factors Research studies indicate that tendency to addiction is

influenced by genetics. Type II alcoholism shows a strong genetic basis. Some people with no family history of alcoholism

develop an alcohol problem.



Alcoholism: Risk factors Exposure to parental conflict, inadequate supervision,

and abuse can increase the likelihood of alcoholism emerging later in life.

Culture also has an influence – prevalence rates vary in different nations and ethnic groups.



Treatment for alcoholism It is very difficult for most people to quit alcohol and the

other drugs. Only 10-20% are successful and relapses are very

common. Many recovering addicts seek help from mental-health

professionals or self-help groups. Such help improves the chances of successful recovery,

but offers no guarantees.



Treatments for alcoholism Detoxification is a program of supervised recovery

provided in a hospital setting. Outpatient mental-health treatment has about the same

rate of success as detoxification.



Treatments for alcoholism The most widespread treatment for alcoholism is offered

by Alcoholic Anonymous (AA). AA is a self-help group comprised of people who abstain

from alcohol use and offer help and support to each other.



Treatments for alcoholism Antabuse is the trade name for disulfiram. Alcoholics who take Antabuse daily become very sick

when they drink alcohol. This treatment is only moderately effective.



Treatments for alcoholism Controlled drinking refers to reducing consumption of

alcohol from dependent/abusive to moderate levels. Some physicians believe that abstinence is workable for

all alcoholics and believe this is a viable alternative. Harm reduction is a similar approach applied to drug

abuse. These methods are highly controversial



Opiate dependence A very difficult withdrawal syndrome complicates

recovery from dependence on opiate drugs (i.e. heroin, morphine).

Some opiate addicts go “cold turkey” in order to stop using.



Opiate dependence Recovery programs commonly offer methadone as a

less dangerous replacement for opiates. This is a harm reduction strategy that allows recovering

opiate addicts to remain employed and avoid criminal behavior.


Table 16.4 Comparison of methadone with morphine


Substances, the Individual, and Society

How we handle the problem of substance dependence and abuse in our society remains an area of intense debate.

Our current strategies have not eliminated widespread use.

As a citizen, you may be called upon to think about these issues and help to shape changes in our national drug policy. As you have learned, there are complex and difficult issues involved.


Module 16.3

Mood Disorders


Mood Disorders

Depression Major depression

Major depression is an extreme condition. It usually persists for months. The person experiences little interest in anything, little

pleasure, and little motivation to be productive.


Mood Disorders

Depression Major depression

Loss of interest in food and sex are common. The person has feelings of worthlessness, guilt and

powerlessness over their lives. Sleep abnormalities are associated with depression

(there is a characteristic rapid onset of REM sleep). The person may attempt suicide.


Figure 16.9 When most people go to sleep at their usual time, they progress slowly to stage 4 and then back through stages 3 and 2, reaching REM sleep toward the end of their first 90-minute cycle. Depressed people, however, reach REM more rapidly, generally in less than 45 minutes. They also tend to awaken frequently during the night.


Mood Disorders

Depression Seasonal affective disorder (SAD)

Consistent depression associated with a particular season of winter is called seasonal affective disorder.

It is most common in areas that have little sunlight in the winter.

It can be relieved by light therapy, which requires the depressed person to sit in front of a bright light for a few hours each day.


Figure 16.10 Most people feel slightly better during the summer (when the sun is out most of the day) than during the winter (when there are fewer hours of sunlight). People with seasonal affective disorder (SAD) feel good in the summer and seriously depressed in the winter (or good in the winter and depressed in the summer). Seasonal affective disorder is commonest in far northern locations such as Scandinavia, where the summer days are very long and bright and the winter days are very short and dark. The disorder is unheard-of in tropical locations such as Hawaii, where the amount of sunlight per day varies only slightly between summer and winter.


Mood Disorders

Depression Bipolar disorder

This condition was once referred to as manic-depressive disorder.

It involves a cycling of mood between periods of depression and periods of mania.

Mania is a state of extreme exuberance and agitation.


Mood Disorders

Depression Genetic predisposition to depression

Having close biological relatives who were diagnosed with depression increases one’s probability of becoming depressed.

Having adoptive relatives who were depressed also increases that probability, but not as much.


Mood Disorders

Depression Genetic predisposition to depression

The probability is especially high if one has biological relatives who were diagnosed with depression before age 30.

There is probably no one gene that causes depression.

Genes probably influence temperament and therefore also the way people respond to events in their lives.


Mood Disorders

Depression Sex differences in depression

Before adolescence, depression is about equally common in boys and girls.

From adolescence onward, women are about twice as likely to experience depression as men.


Mood Disorders

Depression Sex differences in depression: hormones

Women experience more rapid hormonal changes than men do (menstrual cycles, pregnancy, childbirth and menopause).

Postpartum depression is triggered by the rapid hormonal changes that follow childbirth.

However, the hormone levels of depressed women are not significantly different that those of non-depressed women.


Mood Disorders

Depression Sex differences in depression: coping

Men generally try to distract themselves when they are feeling depressed. Women tend to dwell on their feelings more.

Ruminating may not be useful for coping and may make the person feel worse.

This explanation does not account for why women and men choose different strategies.


Mood Disorders

Depression Events that precipitate depression

People generally become depressed after losses or other negative events occur.

There is little relationship between the scale of the event and the intensity and duration of the subsequent depression.

Severe losses early in life may make people more vulnerable to depression later on in life.


Mood Disorders

Depression Events that precipitate depression

Lack of social support also increases vulnerability to depression.

As in the case of stress, it is not just the event but also the person’s interpretation of the event’s significance that influences the degree of depression.

The way people think about their lives, as well as the course of the events, is a factor to consider.


Mood Disorders

Depression Cognitive aspects of depression

Every person has an explanatory style in accounting for successes and failures.

Internal attributions cite causes within the person. External attributions identify causes outside the

person.


Mood Disorders

Depression Cognitive aspects of depression

People tend to be more consistent in the type of attributions that they use to explain their failures.

People who blame themselves for all failures, regardless of the circumstances, develop a pessimistic explanatory style.

They view their failures as global (consistent over situations) and stable (consistent over time).

“Depressed people believe that every silver lining has a cloud.”

-- Kalat


Mood Disorders

Depression Treatments for depression

Cognitive therapy helps the individual develop more positive beliefs.

Drug therapies use anti-depressant medications including the tricyclics, selective serotonin reuptake inhibitors, monoamine oxidase inhibitors, and atypical antidepressants.

St. John’s Wort is a naturally occurring herb that has antidepressant effects. It should not be used with other medications.


Figure 16.13 Antidepressant drugs prolong the activity of the neurotransmitters dopamine, norepinephrine, and serotonin. (a) Ordinarily, after the release of one of the neurotransmitters, some of the molecules are reabsorbed by the terminal button, and other molecules are broken down by the enzyme monoamine oxidase (MAO). (b) Selective serotonin reuptake inhibitors (SSRIs) prevent reabsorption of serotonin. Tricyclic drugs prevent reabsorption of dopamine, norepinephrine, and serotonin. (c) MAO inhibitors (MAOIs) block the enzyme monoamine oxidase and thereby prolong the effects of the neurotransmitters.


Mood Disorders


Electroconvulsive shock therapy (ECT) is a well-known but controversial treatment.

A brief electrical shock is administered to the patient’s head.

It induces a convulsion similar to an epileptic seizure. How it works is not fully understood.


Mood Disorders


It is an effective treatment, although the benefits are temporary. Other treatments must be offered also.

ECT fell out of favor because it was widely abused (administered without patient consent, given too often, used as a threat).

It is now used only for patients who have treatment-resistant depressions or who are strongly suicidal.


Mood Disorders

Bipolar disorder Bipolar disorder: symptoms

People whose moods alternate between extremes of mania and depression are said to suffer from bipolar disorder.

When they are experiencing mania, they are constantly active and uninhibited, and may be very happy or very irritable.


Mood Disorders

Bipolar Disorder Bipolar Disorder: types

Psychologists diagnose two types of bipolar disorder. Bipolar I disorder involves the experience of at least

one episode of mania. Bipolar II disorder involves alternation between

major depression and hypomania, which is a milder form of mania.


Mood Disorders

Bipolar disorder Bipolar disorder: prevalence

About 1% of the adult population of the U.S. has been diagnosed with a Bipolar Disorder.

It can be difficult to distinguish bipolar from other disorders (attention deficits, delusions and hallucinations are also symptoms of other disorders).

There are hereditary influences on bipolar disorder.


Mood Disorders

Bipolar disorder Drug therapies for bipolar disorder

Lithium is a naturally occurring chemical that is used to treat mania.

How lithium relieves mania is not well understood. Lithium is toxic at high doses, so a patient who takes

it must be carefully monitored. Valproate and anticonvulsant drugs are also used

to treat bipolar disorders.


Mood Disorders

Suicide Mood disorders and suicide

People who suffer from depression and bipolar disorders consider suicide. Some make attempts.

It is hard to know the true rate of suicide because some suicides are disguised to look like accidents.

Suicide rates vary as a function of gender, culture and age


Figure 16.15 Suicide rates differ as a function of age, gender, and culture. The rates shown here are for 1988; the rate has dropped since then for Hungary, presumably because of economic and social changes within the country. (Based on data of Lester, 1996)


Figure 16.15 Suicide rates differ as a function of age, gender, and culture. The rates shown here are for 1988; the rate has dropped since then for Hungary, presumably because of economic and social changes within the country. (Based on data of Lester, 1996)


Table 16.5 People most likely to attempt suicide


Mood Disorders


Women make more attempts but tend to employ less lethal means than do men.

There is no dependable pattern to suicide, but certain warning signs and risk factors are associated with it.

Previous attempts, a history of losses, a recent loss, and a family history are all likely to raise the risk.


Mood Disorders


If someone you know is thinking of suicide, try to treat the person as you would any other person who is in distress.

Offer support and friendship, and don’t be afraid to ask him or her to talk about feelings.

Encourage the person to seek professional help if you sense that they are open to the suggestion.


Mood and Mood Disorders

Our capacity to experience emotions is an important part of our lives. We have a wide range of pleasant and unpleasant feelings to color our days.

Mood disorders go beyond this typical spectrum, and victimize the person, distorting their perspective. Our ways to manage these disorders have improved over the past decades, providing many with relief from this distortion.


Module 16.4

Schizophrenia


Schizophrenia

What is schizophrenia? Many people confuse the term schizophrenia with

dissociative identity disorder or multiple personality disorder.

The split in schizophrenia refers to a disconnection of the intellectual and emotional aspects of the personality.


Figure 16.16 Although the term schizophrenia is derived from Greek roots meaning “split personality,” it does not refer to cases where people alternate among different personalities. Rather, the term originally indicated a split between the intellectual and emotional aspects of a single personality.


Schizophrenia

What is schizophrenia? The DSM-IV diagnosis of schizophrenia requires that the

person exhibit a complete deterioration of daily activities along with at least two of the following symptoms:

Hallucinations Delusions or thought disorders Incoherent speech Grossly disorganized behavior Loss of normal emotional responses and social

behaviors


Schizophrenia

Symptoms of schizophrenia It is possible for two people with schizophrenia to have

very different symptom patterns The symptoms are divided into two broad types. Positive symptoms are behaviors that are notable

because of their presence (hallucinations and delusions, for example).

Negative symptoms are behaviors that are notable because of their absence (lack of emotional expression).


Schizophrenia

Symptoms of schizophrenia Positive symptoms

Hallucinations are false sensory experiences. Hearing voices is a common auditory hallucination of

schizophrenia. Visual hallucinations occur but are less common.


Schizophrenia


Delusions are unfounded beliefs. There are three types of delusions associated with

schizophrenia – persecution, grandeur, and ideas of reference.

As it is sometimes hard to distinguish between the unusual opinion and a delusion, one cannot diagnose a psychotic disorder on the basis of such ideas alone.


Schizophrenia


Disordered thinking refers to a deficit in utilizing “executive functions.”

Deficits of attention, difficulty in switching rules and routines, loose associations, and difficulties with abstraction are all common types of disordered thinking in people suffering from schizophrenia.


Schizophrenia

Types and prevalence Four types of schizophrenia

Undifferentiated Catatonic Disorganized Paranoid


Schizophrenia

Four types of schizophrenia The symptoms of undifferentiated schizophrenia

include: Deterioration of daily functioning Hallucinations Delusions or thought disorders Inappropriate emotions

None of the symptoms is unusually pronounced or bizarre.


Schizophrenia

Four types of schizophrenia Catatonic schizophrenia is distinguished by prominent

movement disorder, including either: Rigid inactivity Excessive activity The person is aware of his or her surroundings, but

the nature of the individual’s posture or movement has no relationship to the outside world.


Schizophrenia

Four types of schizophrenia The symptoms of disorganized schizophrenia include:

Incoherent speech Extreme lack of social relationships “Silly” or odd behavior


Schizophrenia

Four types of schizophrenia The symptoms of paranoid schizophrenia include:

Elaborate hallucinations and delusions The delusions have pronounced themes of

persecution and grandeur. Other thought problems tend to be less pronounced,

and some people with paranoid schizophrenia are relatively intact cognitively.


Schizophrenia

Prevalence Prevalence of schizophrenia

About 1% of Americans are afflicted with schizophrenia at some time in the lifespan.

In general, the rates of this disorder have been declining over the past 100 years.

It occurs in many cultures, but is less common in developing nations.


Schizophrenia

Prevalence Prevalence of schizophrenia

Schizophrenia is most frequently diagnosed in young adults.

Men are usually diagnosed earlier than women. The onset is typically sudden, although there are

some markers during childhood.


Schizophrenia

Causes Genetic influences

Studies of twins and adopted children suggest a genetic basis for the disease.

In identical twins, if one member of the pair develops schizophrenia, there is a 50% chance that the other will also.

As with most other genetic research, it is difficult to control for the effects of the prenatal environment.


Figure 16.18 The relatives of a schizophrenic person have an increased probability of developing schizophrenia themselves. Note that children of a schizophrenic mother have a 17% risk of schizophrenia even if adopted by a family with no schizophrenic members. (Based on data from Gottesman, 1991)


Schizophrenia

Causes Genetic influences

So far researchers have not located a specific gene for schizophrenia.

It is probably not a single-gene disorder. It appears that certain people develop it without a

genetic basis.


Schizophrenia

Causes Brain damage may have some influence on the

development of schizophrenia. Brain scans indicate that: The hippocampus and parts of the cerebral cortex are

a little smaller than normal. The cerebral ventricles are larger than normal. People with schizophrenia have smaller neurons and

fewer synapses in the prefrontal cortex.


Schizophrenia

Causes The neurodevelopmental hypothesis

The neurodevelopmental hypothesis states that schizophrenia is the result of nervous system impairments that develop before or at birth.

These impairments may be due to genetic or other reasons.

Non-genetic risk factors include: poor prenatal care, difficult pregnancy and labor, and mother’s exposure to influenza virus.


Schizophrenia

Therapies for schizophrenia Drug therapies

Antipsychotic or neuroleptic drugs help to relieve the symptoms of schizophrenia.

These drugs work gradually and vary in effectiveness from patient to patient.


Schizophrenia


Antipsychotic drugs work to block the production of dopamine at the synapses, which is evidence for the dopamine hypothesis of schizophrenia.

An alternative explanation is the glutamate hypothesis of schizophrenia, which is supported by the deficient stimulation of glutamate (a neurotransmitter that is inhibited by dopamine).


Schizophrenia


Tremors and involuntary movements begin gradually in people taking antipsychotics for many years, a condition known as tardive dyskinesia.

Atypical antipsychotic medications have been developed to provide relief without this troublesome side effect.

The atypical antipsychotics tend to suppress immune functioning in many patients, however.


Schizophrenia

Therapies for schizophrenia Family therapy for schizophrenia

Because caring for a schizophrenic family member can be stressful, family therapy can be useful in a number of ways.

It provides direct support for the healthy family members.

It reduces the additional risk to the patient by circumventing negative reactions to him or her by family members that might promote relapse.


Figure 16.20 This graph indicates that during 2 1/2 years following apparent recovery from schizophrenia, the percentage of schizophrenic patients who remained improved is higher in the group that received continuing drug treatment than in the placebo group. But the graph also shows that antipsychotic drugs do not always prevent relapse. (Based on Baldessarini, 1984)


The Elusiveness of Schizophrenia

Two people with schizophrenia may present their illness in very different ways. The causes of their illnesses may turn out to be very different.

Psychologists are still uncertain whether we are looking at one disorder or several. We still have so much to learn about this complex illness.

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