MENTAL ILLNESS – PART 1Intro to Psych5/6/14
MENTAL ILLNESS What are we going to talk about today?
How modern clinical psychology looks at mental disorders
Some of the ways we think about what makes a mental disorder
Characteristics common across mental disorders How we think about mental disorders
Mood disorders Depression Bipolar Disorder
Theories Treatments
ABNORMALITY Most basic and foundational question in
clinical psych: “What is abnormality?” Where do we draw the line between healthy
behavior & unhealthy behavior? Psychologists don’t have an easy way to diagnose
abnormality They use a series of 3 criteria to help them diagnose
different mental disorders1. Behavioral criteria: Set of symptoms the person
reports How they feel How they think
2. What the psychologist observes about their behavior and how typical or atypical it is
3. These observed & reported criteria get matched against the clinical criteria psychologists know go with different disorders
ABNORMALITY Many of these criteria are very subjective
and can be influenced by many factors Social Norms: what your society or culture views
a normal Example: A Muslim woman wearing a veil is typical
behavior in a Muslim community A woman wearing a veil in a non-Muslim community
appears atypical Characteristics of the target person
Example: Gender A man crying in our culture is often seen as unusual,
but a woman crying is much less unusual A woman beating the crap out of someone is
unusual but less so for a man Stereotypes for acceptable behavior can influence
whether something is normal or abnormal
ABNORMALITY Influences on normal vs abnormal, continued
Context Example: Paranoia
Paranoid and hyper-vigilant and live in downtown Kabul, that’s adaptive behavior and not necessarily abnormal
Paranoid and hyper-vigilant in a tiny farm town in Western MA, that’s not as normal or adaptive
ABNORMALITY Three characteristics of abnormality: 1) Distress
Behaviors that cause the person or others around them distress Example: Depression
You’re unhappy, sad, may even feel bad enough to want to kill yourself
Example: Antisocial Personality Disorder The person has no regard for the rights of others,
has no hesitation to steal or hurt other people, has no empathy or sympathy for others’ feelings – harms other people
ABNORMALITY 2) Dysfunction
A set of behaviors that prevents the person from functioning in daily life Example: Depression
People who are depressed often become non-functional: can’t get up & go to class, can’t go to work, can’t hang out with their friends. They withdraw and become totally isolated and cease to function
3) Deviance: highly unusual behaviors and feelings Most controversial of the 3 – heavily influenced
by social norms. What’s deviant in one culture may not be in another
ABNORMALITY How is all of this pulled together to make a
diagnosis? Diagnostic & Statistical Manual (DSM)
Been around since the 1950’s Currently in its 5th edition Early editions were HIGHLY subjective Since the 80s, there has been an effort to make it more
objective The DSM gives lists of symptoms required for diagnosis
and the number of symptoms that have to be present Notions of distress, dysfunction, and deviance are
built in to the symptoms
MOOD DISORDERS One of the most common problems people
face 22% of women will have an episode of
serious depression in their lives 13% of men will Late adolescent years and the early 20s are
the peak time for first onset of mood disorders such as depression and bipolar disorder
Divided in to 2 categories: Unipolar Depression Disorders
Depression only Bipolar Disorders
The person cycles between depression and mania
UNIPOLAR DISORDERS DSM criteria for Major Depression1. Sadness or diminished interest or pleasure
in usual activities (anhedonia)2. At least 4 of the following symptoms:
1. Significant weight or appetite change2. Insomnia or hypersomnia3. Psychomotor retardation or agitation4. Fatigue or loss of energy5. Feelings of worthlessness or excessive guilt6. Diminished ability to concentrate,
indecisiveness7. Suicidal Ideation or behavior
3. Duration of at least 2 weeks (average length of a depressive episode is 6 months, if not treated)
UNIPOLAR DISORDERS It’s important to understand the difference
between an everyday sad mood and the debilitating, overwhelming depression of Major Depression
You may be bummed because you got dumped or bombed a test, but it’s very different from the non-functional, vegetative experienced of MD
This doesn’t mean nothing is wrong though. Depression runs on a continuum There are many people who may not be severely
depressed, but that doesn’t mean they wouldn’t benefit from help
Moderate forms of depression can morph into more severe forms if left untreated
BIPOLAR DISORDERS Bipolar Disorder is characterized by a periods of
depression and periods of mania DSM Criteria for a Manic Episode1. Abnormally and persistently elevated,
expansive, or irritable mood for at least 1 week2. 3 or more of the following:
1. Inflated self-esteem or grandiosity2. Decreased need for sleep3. More talkative than usual, pressure to talk4. Flight of ideas, racing thoughts5. Distractibility6. Increase in goal-directed activity, agitation7. Excessive involvement in pleasurable but
dangerous activities
BIPOLAR DISORDERS Here is an example of a guy who is pressured to
speak. He’s just talking and talking even though there’s no one there to talk to or prompting him to talk http://youtu.be/Lm0VZX2_Ir8
Just like depression, mania runs on a continuum from mild to extremely severe or psychotic. This guy’s mania may not be on the severe end of the continuum, but you can see it still affects him
Those on the severe end may lose touch with reality and they'll believe that they are a supernatural being. They may believe that they are the Messiah or that they are Albert Einstein come back to life, or that they have supernatural powers
BIPOLAR DISORDERS Mania can get people into trouble
Sexual promiscuity with the risk of STDs Illegal drug activity and/or arrest Bankruptcy for them and/or their families
These negative consequences are what motivate people to get help Mania itself isn’t usually what drives a person to
help; mania can be pleasurable to have The eventual cycle into debilitating
depression also drives people to seek help – the mania will eventually end
Bipolar disorder occurs in 1% of the population
THEORIES AND TREATMENTS There are 3 different categories of theory and
treatment: Biological Theories and Treatments Cognitive Behavioral Theories and Treatments Interpersonal Theories and Treatments
THEORIES AND TREATMENTS Biological
Genetics play a big part in mood disorders, especially bipolar disorder Identical twins: if one twin has bipolar disorder, the other
twin has over a 60% chance of also having the disorder Fraternal twins: if one twin has bipolar disorder, the other
twin has a 12% chance of also having it The farther away you are on the family tree from a
relative with bipolar, the lower your genetic chances of having it are
Genetics and major depression Some versions of depression have higher genetic
likelihood “Early Onset Depression” begins in childhood and has a
higher genetic component to it Depression trigger by a major life event (trauma, loss) is
less clearly linked to genetics
THEORIES AND TREATMENTS Biological, continued
Neurotransmitters and mood disorders Serotonin Norepinephrine Dopamine An imbalance of any of these 3 neurotransmitters can
lead to depression or bipolar disorder
THEORIES AND TREATMENTS Biological, continued
Prefrontal Cortex is where complex thinking, problem solving, and goal-directed behavior happens In people with depression, there is lowered activity in
the prefrontal cortex Amygdala is where the processing of emotion
info happens People with mood disorders (both bipolar &
depression) have overactive amygdala responses to emotional info
Hippocampus has a big role in memory and concentration People with chronic depression have hippocampi that
have shrunk, which may be related to their problems with concentration and paying attention
THEORIES AND TREATMENTS
THEORIES AND TREATMENTS Biological Treatments
Medications Monoamine oxidase inhibitors (MAOI) Tricyclic antidepressants
60% of people who take these do well Lots of side effects, can be fatal in overdose
Selective serotonin re-uptake inhibitors (SSRIs) Paxil, Prozac, etc Most commonly prescribed, have fewer side effects
Lithium for bipolar disorder Tons of side effects Dangerous for women to take while pregnant Only treats manic episodes, does not treat
depression
THEORIES AND TREATMENTS Cognitive Behavioral Theories
Applies mostly to depression People who are depressed have a negative view
of the self, the future, and the world These beliefs are fed by biases in the person People who are depressed show distortions in
thinking “All-or-nothing” thinking: things are good or bad only “Emotional Reasoning”: if I feel like a loser, I must be a
loser “Personalization”: Self-blame
These distortions in thinking & interpreting situations feed the general negative view of the self and hopelessness about the future
THEORIES AND TREATMENTS Cognitive Behavioral, continued
People with depression make attributions for negative internal events (they blame themselves)
They see bad things as lasting forever They see bad events as affecting many areas of
their life All of these feelings feed their depression and
their general belief that life is terrible
THEORIES AND TREATMENTS Cognitive Behavioral Therapy (CBT)
Identify themes in negative thoughts and triggers for them
Challenge negative thoughts What is the evidence for this interpretation? Are there other ways of looking at the situation? How could you cope if the worst did happen?
Help clients recognize negative beliefs or assumptions
Change aspects of environments related to depressive symptoms
Teach person mood-management skills that can be used in unpleasant situations
CBT is extremely effective
THEORIES AND TREATMENTS CBT, continued
CBT has been shown to be effective in helping people out of a current depressive episode and also in preventing future episodes
Patients learn new coping skills for dealing with new stressors and are better able to keep from falling into a depressive state again
One of the most important parts of CBT is that what happens in therapy is important, but what happens OUTSIDE of therapy that’s most important
The patient must practice the skills CBT has taught them so they can learn how to use them once therapy has concluded
THEORIES AND TREATMENTS Interpersonal Therapy
Based on the theory that negative views of the self and expectations about the self and relationships are based on upbringings in environments that fostered these kinds of negative self-views
Interpersonal therapy works to help the patient understand that their negative self-views are rooted in past relationships
Interpersonal Therapy is very focused on the past CBT is focused only on the present and future
The good news is there are many medications and therapy treatments to help people overcome their
depression