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Psychological Disorders I: Anxiety

Brian J. Piper, Ph.D., M.S.

Goals

• History of Psychological Disorders

• Anxiety Disorders

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Evil Spirits

• Release the demons!

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The Moral Model

Philippe Pinel from France insisted that madness was not due to demonic

possession but an ailment of the mind.

Philosophy:•Treat each patient as an individual•Employ former patients•Use psychological interventions before biological ones.

“the treatment of insanity (l’aliénation mentale) without considering the differentiating characteristics of the patients [la distinction des espèces] has been at times superfluous, rarely useful, and often harmful”

1745-1826

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Medical Model

When physicians discovered that syphilis led to mental disorders, they started using medical models

to review the physical causes of these disorders.

1. Etiology: Cause and development of the disorder.

2. Diagnosis: Identifying (symptoms) and distinguishing one disease from another.

3. Treatment: Treating a disorder in a psychiatric hospital.

4. Prognosis: Forecast about the disorder.

The Biopsychosocial Approach

Assumes that biological, socio-cultural, and psychological factors combine and interact

to produce psychological disorders.

International Classification of

Diseases-10

• Published by the World Health Organization to provide uniformity.

• International Statistical Classification of Diseases and Related Problems uses 6 digit codes.

• Started in 1900, included mental disorders in 1949

Diagnostic & Statistical Manual (DSM)

• Published by American Psychiatric Association

• DSM-I: 1952: consists of 106 mental disorders

• DSM-II: 1968: psychodynamic

• DSM-III: 1980: responds to Rosenhan criticisms

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Diagnostic & Statistical Manual of Mental Disorders (DSM)

• Published by American Psychiatric Association

• DSM-I: 1952: consists of 106 mental disorders

• DSM-II: 1968: psychodynamic

• DSM-III: 1980: responds to Rosenhan criticisms

• DSM-IV: 1994: 297 disorders

• DSM-V: in planning for 2013

Example: ADHD: Inattentive• Symptoms present at school/work and home

• 6+ symptoms that have persisted 6+ months and are inconsistent with developmental level– Often fails to give close attention or makes careless

mistakes at school or at work.

– Has difficulty sustaining attention in tasks or play.

– Does not listen when spoken to directly.

– Often does not follow through on instructions.

– Has difficulty organizing activities.

– Is easily distracted.

– Is often forgetful in daily activities.

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ADHD: Hyperactive-Impulsive• Symptoms present at school/work and home

• 6+ symptoms that have persisted 6+ months and are inconsistent with developmental level– Often fidgets with hands or feet, leaves seat when

staying seated is expected, runs or climbs excessively

– Often acts as “driven by a motor”– Often blurts answer before ? Completed– Has difficulty waiting turn– Often interrupts others

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Joel T. Nigg, Ph.D.

Labels

Anxiety

• Anxiety (future) versus Fear (current)

• Timing

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Measuring Anxiety I: Open-field

Measuring Anxiety II: Elevated Plus Maze

• Developed by Sandra File, Ph.D.• Valium Type Drugs: decrease anxiety • http://www.youtube.com/watch?v=PLcX2MbpmdY

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ChlordiazepoxidePellow et al. (1985). J Neurosci Methods 14, 149-167.

Anxiety Disorders

Panic Disorder

Phobias

Generalized Anxiety Disorder

Obsessive-Compulsive Disorder

Post-Traumatic Stress Disorder

Panic Disorder

Panic Attack: discrete period of intense fear, 4+ symptoms develop abruptly and peak within 10 minutes:

1) palpitations2) sweating3) trembling4) shortness of breath5) choking feeling6) chest pain7) dizziness8) nausea9) losing control10) fear of dying

Panic Disorder

Panic Attack: discrete period of intense fear, 4+ symptoms develop abruptly and peak within 10 minutes

Individual Differences: multi/day versus 1/week

Agoraphobia: fear of open-spaces

Treatment: anti-anxiety & anti-depressant drugs1st 2:30

http://www.youtube.com/watch?v=2gNGUartUEI

Phobia

• Marked & persistent fear that is excessive or unreasonable, cued by presence or anticipation of object/situation

• The avoidance interferes significantly with normal routine, occupational or social activities.

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Kinds of Phobias

Phobia of blood.Hemophobia

Phobia of closed spaces.

Claustrophobia

Phobia of heights.Acrophobia

Phobia of spiders.Arachonophobia

Systematic Desensitization

• 1) Create hierarchy of fears

• 2) Relaxation techniques

• 3) Combine

Spider

↓

Joseph Wolpe, M.D.

1915-1997

Obsessive-Compulsive Disorder (OCD)

Obsessions: recurrent thoughts, images, or feelings

Compulsions: ritualistic behaviors, performed to stop obsession and associated anxiety

Common Obsessions:1)Dirty 2) Aggression 3) Religion 4) Sex

DifferentiationQuantitative: High intensity, frequency, duration ( > 1 hour/day)

Source: Anna M. Kring, Ph.D.; DSM-IV TR

Quantification

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To take test: http://www.psymed.info/psymed/default.aspx?m=Test&id=52&l=3

OCD

• 1st Two Minutes:

• http://www.youtube.com/watch?v=44DCWslbsNM

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Cingulate Cortex

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Anterior Cingulate & OCD

• OCD and controls completed a difficult continuous performance test during fMRI.

• OCD > controls in Anterior Cingulate Cortex

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Ursu et al. (2003). Psychological Science, 14, 347-353.

Generalized Anxiety Disorder

A.  Excessive anxiety and worry (apprehensive expectation), occurring more-days-than-not for at least 6 months.

B. The person finds it difficult to control the worry.

C. three (or more) of the following six symptoms:1. Restlessness2. Being easily fatigued3. Difficulty concentrating4. Irritability5. Muscle tension6. Sleep disturbance

DSM-IV-TR Criteria

Post-Traumatic Stress Disorder

Four or more weeks of the following symptoms constitute Post-Traumatic Stress Disorder (PTSD):

Re-experiencing: nightmares, flashbacks, intrusive thoughts

Avoidance: situation & associated

Physical Arousal: sleep, concentration, irritability

Significant social or occupational impairment3 min: http://www.youtube.com/watch?v=7aFs6695VyQ

PTSD

• Lifetime Prevalence: 5% men, 10% women

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Resilience to PTSD

Only about 10% of women and 20% of men react to traumatic situations and develop PTSD.

Holocaust survivors show remarkable resilience against traumatic situations.

Origins of Anxiety

• Learn: videotapes of fear response to fake snake or plastic flower

• Test: show a stimuli

Mineka, S. (1985). J Abnormal Psychol

Origins of Anxiety

• Learn: videotapes of fear response to fake snake or plastic flower

• Test: show a stimuli• Response: Snake-Fear; Flower- No Fear• Supports Social-Learning & Evolutionary

Psychology

Summary

• Psychological Disorders & ICD/DSM• Anxiety Disorders

– Panic Disorder

– Phobias

– GAD

– OCD

– PTSD

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