Copyright © 2010 by Worth Publishers Psychology Fifth Edition Chapter 14: Psychological Disorders Don H. Hockenbury and Sandra E. Hockenbury

Copyright © 2010 by Worth Publishers

PsychologyFifth Edition

Chapter 14:

Psychological Disorders

Don H. Hockenbury and Sandra E. Hockenbury



DSM-IV-TR The Diagnostic and Statistical Manual IV-Text Revision was revised in 2000 with updated research. Since then, the lengthy process of assembling DSM-V has begun. It is a collaborative effort involving several mental health organizations, including the American Psychiatric Association and the World Health Organization. One key goal of DSM-V is to incorporate the multidisciplinary Research advances in mental health that have occurred worldwide in recent years. DSM-V is scheduled to be published in 2012 (Fink & Taylor, 2008).




Abnormal Behavior


What is Abnormal?

•Textbook: “3 D’s”–Distressing

–Dysfunctional

–Deviance


Hollywood Versus Reality In The Dark Knight, the Joker takes the image of the insane killer to new

heights. As a plot device, the deranged, evil killer on the loose is standard fare in

television dramas like CSI and film thrillers like the Halloween and the Friday the 13th movies. Such media depictions foster the stereotype that

people with a mental illness are evil, threatening, and prone to violence—an image that is not supported by

psychological research.

Copyright © 2010 by Worth PublishersFigure 14.2 NCS-R Prevalence and Severity of Mental Disorders




Anxiety Disorders

Fears & Phobias

Obsessive Compulsive

Disorder

Generalized Anxiety Disorder

Panic Disorder


Yuck! It’s hard to suppress a shudder of disgust at the sight of a slug sliming its way across the sidewalk . . . or a cockroach scuttling across the kitchen floor. Are such responses instinctive? Why are people more likely to develop phobias for slugs, maggots, and cockroaches than for mosquitoes or grasshoppers?




Panic Attack! The rapidly escalating physical arousal of a panic attack results in a constellation of frightening symptoms: pounding heart, breathlessness, sweating, trembling, and choking sensations.In panic disorder, panic attacks are frequent and unpredictable, often seeming to happen for no apparent reason.


Obsessive Compulsives

Obsessions: persistent, uncontrollable thoughts



Compulsions: intrusive, inappropriate actions that often prevent obsessions



Obsessions

Anxiety

Compulsions

Reduce



Brain Activity in Obsessive–Compulsive Disorder These PET scans show the change in activity in a brain area called the caudate nucleus before (left) and after (right) therapy for obsessive–compulsive disorder (Schwartz & others, 1996). The caudate nucleus is involved in initiating and controlling movement. In obsessive–compulsive disorder, the caudate nucleus is overactive, as indicated by the bright yellow in the left PET scan. After psychotherapy, the obsessions and compulsions cease, and the caudate nucleus becomes less active (right). In a follow-up study, Sanjaya Saxena and her colleagues (2008) found that such changes could take place after just four weeks of cognitive-behavioral therapy. (We discuss this form of psychotherapy in Chapter 15.)


Social Phobia About one out of eight adults in the United States have experienced social phobia at some point in their lives (Kessler& others, 2005a). Social phobia is far more debilitating than everyday shyness. People with social phobia are intensely fearful of being watched or judged by others. Even ordinary activities, such as eating with friends in a shopping mall food court, can cause unbearable anxiety.


Schizophrenia

• Based on observation and self report

• Signs and Symptoms– Abnormal content of thought– Illogical form of thought– Distorted perception– Changed affect– Impaired sense of self– Impaired interpersonal functioning



Glimpses of Schizophrenia This drawing was made by a young man hospitalized for schizophrenia. He drew the picture while he was hallucinating and extremely paranoid. The drawing provides glimpses of the distorted perceptions and thoughts that are characteristic of a schizophrenic episode. Notice the smaller face that is superimposed on the larger face, which might represent the hallucinated voices that are often heard in schizophrenic episodes.


The Hallucinating Brain

Researcher David Silbersweig and his colleagues (1995) used PET scans to take a “snapshot” of brain activity during schizophrenic hallucinations. The scan shown here was recorded at the exact instant a schizophrenicpatient hallucinated disembodied heads yelling orders at him. The bright orange areas reveal activity in the left Auditory and visual areas of his brain, but not in the frontal lobe, which normally is involved in organized thought processes.





Identical Twins but Not Identical Brains David and Steven Elmore are identical twins, but they differ in one Important respect—Steven (right) has schizophrenia. Behind each is a CAT scan, which reveals that Steven’s brain is slightly smaller, with less area devoted to the cortex at the top of the brain. Steven also has larger fluid-filled ventricles, which are circled in red on his brain scan. As researcher Daniel Weinberger (1995) commented, “The part of the cortex that Steven is missing serves as perhaps the most evolved part of the human brain. It performs complicated tasks such as thinking organized thoughts. This might help explain why paranoid Delusions and hallucinations are characteristic of schizophrenia.”


Distinguishing features

• flat, dull, inappropriate mood, blank stare

• confused thinking, rambling train of thought

• detachment, absorption in private world• severely reduced motivation, indecision


Positive Symptoms of Schizophrenia

• Hallucinations

• Delusions

• Disturbances in Form of Thought or Speech

• Grossly Disorganized Behavior

• Inappropriate Affect

Copyright 1998 Allyn & Bacon


Negative Symptoms of Schizophrenia

• Social Withdrawal

• Apathy• Loss of

Motivation• Lack of Goal-

Directed Activity

• Very Limited Speech

• Slowed Movements

• Poor Hygiene and Grooming



Types of Schizophrenia

• Catatonic

• Disorganized

• Paranoid

• Undifferentiated



Causes of Schizophrenia

• Genetic Inheritance

• Excessive Dopamine Activity



Ventricle Example

Cortex Cross-Sections

Normal Schizophrenic


Genetics?• 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).


Types of Schizophrenia• Type I

– positive symptoms– sudden onset– responds to antipsychotic meds rapidly

• Type II– negative symptoms– poor response to antipsychotic meds– brain atrophy???


Phases of Schizophrenia

• Acute Episode– Rapid deterioration, weeks or months

• 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...........


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).


Prodromal....clear deterioration not due to

substances

–Typical symptoms• marked social isolation or withdrawal

• impairment in role functioning

• markedly peculiar behavior

• digressive, vague or poverty of speech

• odd beliefs or thinking

• unusual perceptual experiences


• Residual Phase–Psychotic features may be absent

–Sense of apathy

–Difficulties in thinking, language–Harboring unusual ideas


Subtypes of Schizophrenia

• Catatonic: rigid posturing, stupor

• Disorganized: silly, giddy, emotional

• Paranoid: Delusions of persecution, often anger

• Undifferentiated type: multiple

• Residual type: Previous episodes, currently not psychotic, mild signs


Other Psychosis Schizophreniform Disorder: same

symptoms, 1 - 6 months Schizoafftective Disorder: hallucinations,

delusions plus mood disturbances

Delusional Disorder Brief Psychotic Episode Substance Induced Psychotic Disorder Psychotic Disorder due to....(specific

medical condition)


Prognosis (1 year)

(APA Data, 1994)



Treatment

• there are two very effective treatments for depression--medication and psychotherapy

• almost 80% of people with depression improve with these treatments

• depression becomes more difficult to treat the longer its symptoms go untreated

• without proper treatment, 10 to 15% of people who suffer depression commit suicide.


St John’s Wort There is considerable There is considerable

public interest in claims public interest in claims that extracts from the herb that extracts from the herb Hypericum perforatumHypericum perforatum, , commonly known as St. commonly known as St. John’s wort, may be an John’s wort, may be an effective treatment for effective treatment for depression. Although St. depression. Although St. John’s wort is widely John’s wort is widely prescribed in Europe, prescribed in Europe, clinical research in the USA clinical research in the USA is incompleteis incomplete..


Gender & Depression

(Data from Kessler, et al., 1994)


Seasonal Affective Disorder

• A greater than normal mood fluctuation with the seasons

• Related to amount & intensity of light


Seasonal Affective Disorder

(After Wurtman & Wurtman,1989)


Bipolar Disorder

• Manic episodes & extreme depression mixed with normal affect

• Mania involves delusional levels of optimism, euphoria, & energy

• Equally common in both sexes

• Sufferers make poor decisions while manic, withdraw when depressed



Bipolar Disorder

(Data from Kessler, et al., 1994)


Genetic Connection

• Moderate in major depressive disorder

• Strong in bipolar depression


Causes & Treatments

• Depression:

low norepinephrine & serotonin levels

• Mania:

high norepinephrine levels

• Major Depressive Disorder:

serotonin selective reuptake inhibitors (e.g. Prozac)


Causes & Treatments

• Bipolar Depression:

lithium carbonate

• Neurotransmitter levels may be symptomatic of depression, not causal

• Cognitive theory attributes depression to distorted thinking


Distorted Thinking

• Includes negative views of the world, the future, the self

• Tied to poor reality testing, learned helplessness


Causes of Major Depression and Bipolar Disorder

• The Biological Perspective

• The Cognitive Perspective

• The Psychodynamic Explanation



Mood Disorders

• Major Depressive Disorder

• Seasonal Depression

• Bipolar Disorder





Brain Activity During the Extremes of Bipolar Disorder These PET scans record the brain activity of an individual with bipolar disorder as he cycled rapidly from depression to mania and back to depression over a 10-day period. In the top and bottom PET scans, the blue and green colors clearly showthe sharp reduction in overall brain activity that coincided with the episodes of depression. In the Center PET scans, the bright red, orange, and yellow colors indicate high levels of activity in diverse brain regions during the intervening episodes of mania.Source: Lewis Baxter and Michael E. Phelps, UCLA School of Medicine.


Major Depressive Disorder

• Overwhelming feelings of sadness, despair, hopelessness

• Loss of interest in pleasurable activities


Common Symptoms

• Mood swings• Tearfulness• Irritability• Apathy• Loss of energy• Concentration/attention problems• Indecision• Pervasive mood of sadness


Symptoms.....• Negativity and pessimism

• Guilt, self-reproach

• Psychomotor retardation or agitation

• Changes in appetite, weight

• Sleep difficulties

• Thoughts of death or suicide

• Withdrawal

• Feelings of hopelessness


Variations in Depression

•ReactiveReactive•Endogenous, chronicEndogenous, chronic•Drug inducedDrug induced•Medically related (surgery, Medically related (surgery,

postpartum)postpartum)•BereavementBereavement•Agitated depressionAgitated depression•Seasonal Affective DisorderSeasonal Affective Disorder


Dual Diagnosis• Substance abuse and

psychological disorder

• Depression common

• Schools of thought

–alcohol causes depression (depressant)

–depression leads to use of alcohol


• When depression goes untreated, When depression goes untreated, its most tragic cost is suicide. its most tragic cost is suicide. Fifteen percent of people in Fifteen percent of people in whom depression is overlooked, whom depression is overlooked, untreated, or improperly treated, untreated, or improperly treated, will commit suicide. This means will commit suicide. This means about 20,000 lives each year, in about 20,000 lives each year, in North America alone.North America alone.

Depression and Suicide


Major Depression and . . . Sheryl Crow Grammy award-winning singer Sheryl Crow has struggled with depression since she was a young child. Of her chronic depression, she has said “I grew up in the presence of melancholy, a feeling of loss… It is a shadow for me. It's part of who I am. It is constantly there. I just know how, at this point, to sort of manage it.”


Carrie Fisher and Bipolar DisorderBest known for her role as Princess Leiain the Star Wars movie trilogy, Carrie Fisher was first diagnosed with bipolar disorder when she was 24 years old. She struggled with drug addiction for several years before finally accepting her diagnosis. “Maybe I was taking drugs to keep the monster in the box,” Fisher (2001) speculates, referring to her bouts of uncontrollable mania. Today, Fisher takes lithium and other medications to maintain an even keel but still sometimes feels tempted to forgo her medications to “ride the white lightning again.” A successful actress in the 1980s, Fishertoday focuses on her writing. She has written novels and screenplays, and she works behind the scenes as a Hollywood script doctor. Other famous people with bipolar disorder include media mogul Ted Turner, actress Patty Duke, and rockmusicians Peter Gabriel and Axl Rose.


Creativity and Mood Disorders Mood Disorders occur more frequently among creative writers and artists than among the general population, leading Some researchers to propose a biochemical or genetic link between mood disorders and the artistic temperament (Jamison, 1993).Writer Mark Twain, novelist Ernest Hemingway, and poet Sylvia Plath all suffered from severe boutsof depression throughout their lives. Both Plath and Hemingway committed suicide, as did Hemingway’s father, brother, and sister. In 1996, Hemingway’s granddaughter, actress Margaux Hemingway, also committed suicide Just one day before the 35th anniversary Of her famous grandfather’s death.



Is Anorexia Glamorous? There is enormous pressure on girls and women to be thin—a pressure that is even more intense in the entertainment world. Not surprisingly, there was a flurry of media attention when Mary-Kate Olsen, one half of the famed Olsen twins, was admitted to a treatment center for anorexia shortly after her 18th birthday. Despite the expressions of concern, the barrage of photos of the wafer-thin Mary-Kate posing in designer clothing tended to glamorize her condition. But there is nothing glamorous about a disorder that can result in heart or kidney failure, osteoporosis (reduced bone density), physical weakness, chronic fatigue, and loss of muscle, hair, and teeth.


Barbie, the American Ideal? If a normal-sized woman(left) was proportioned like a Barbie doll, she would look like the photograph on the right. Yale psychologist Kelly Brownell calculated that if a woman’s hips stayed the same size, she would have to gain nearly a foot in height, add four inches to her chest, and lose five inches from her waist to meet the impossible standard set by Barbie. Many psychologists believe that such unrealistic standards contribute to the incidence of eating disorders in Western cultures.




“Tell me more about these nine separate and distinct personalities.”

© John Caldwell

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Copyright © 2010 by Worth Publishers Psychology Fifth Edition Chapter 14: Psychological Disorders Don H. Hockenbury and Sandra E. Hockenbury