DISSOCIATIVE DISORDERS

 A breakdown of normal personality integration, resulting in significant alterations in memory or identity

Disociative Identity Disorder (DID)

2 or more separate personalities

Prevalence:     Unsure

Psychogenic fugue

Person loses memory, wanders far away, and starts a new identity

Psychogenic amnesia

  Loses memory for stressful events

 Trauma dissociation theory

 Development of new personalities occurs in response to stress: ie-sexual abuse

MOOD DISORDERS

-          Disorders in which there are disabling disturbances in emotion

-          Includes everything from the sadness of depression to the elation and irritability of bipolar disorder

MAJOR DEPRESSIVE EPISODE

-          Intense depressed state that leaves one unable to function in life (2wks)

-          SYMPTOMS (CARDINAL ONES)- to major depressive episode (5 total)

- Negative mood (emotional symptoms), Anhedonia, cognitive, motivational, somatic

Anhedonia

-          Cognitive Symptoms

o       Problems concentrating, making decisions, pessimism, low self worth

o       Can’t get things started, no drive to do anything (related to anhedonia), psychomotor retardation

-          Somatic symptoms

o       Loss/increase in appetite or weight, sleep disturbance, sexual functioning/desire

DEPRESSIVE EPISODE

MAJOR DEPRESSIVE DISORDER

-          Must meet criteria for a depressive episode

o       May have recurrent episodes

BIPOLAR DISORDER

-          Originally known as manic-depressive disorder

o       The manic phase involves rapid speech, inflated self esteem, impulsiveness, euphoria and decreased need for sleep

-          In the depressed phase, the person is moody and sad with feelings of hopelessness

-          Ppl w/ bipolar disorder cycle between the manic and depressed phases

DYSTHYMIA

-          Chronic disorder

-          Depressed mood most of the day, for more days than not, for at least 2 yrs

-          Never been w/o symptoms for more than 2 months

-          Never been manic episode

PREVALENCE & Gender Diff. & Onset

-          Depression

o       15% will suffer from depression

o       More common in women than in men

o       Onset: childhood- old age; mean of 40 yrs 50% have an onset between 20 and 50 yrs

PREVALENCE & Gender Diff. & Onset

-          Bipolar

BIOLOGY OF MOOD DISORDERS-- Depression

Genetic

o       Monozygotic Twins- 67% concordance rate

o       Dizygotic Twins- 15%

o       1.5 times more common in 1^st degree relatives

-          1^st degree rel. have rates of 4%- 24%

-          Neurotransmitters involved

o       Norepinephrine, dopamine, serotonin

o       Mania: overproduction

o       Depression: underproduction

COGNITIVE THEORIES

-          Believe that you are defective, worthless and inadequate

-          Believe that only bad things will happen

-          Bad things will continue to happen b/c of personal defects

LEARNED HELPLESSNESS & internal/external attributions

-          Expect that bad events will occur

-          There is nothing I can do about it

-          Stop trying and give up

-          INTERNAL ATTRIBUTIONS- made for setbacks

-          EXTERNAL ATTRIBUTIONS- made for success

EATING DISORDERS, What & 2 commons

-          Severe disturbances in eating behaviors

o       Preoccupation with weight and controlling that weight

-          Anorexia Nervosa and Bulimia Nervosa

ANOREXIA NERVOSA

-          Restricting Type

o       No bingeing or purging behavior

-          Binge eating/Purging type

o       Episodes of bingeing and/or purging

-          No understanding of negative effects of condition

-          90% of cases occur in females

-          4% adolescent & young adults

-          10% long-term mortality rate

o       (death often occurs from starvation, suicide, or electrolyte imbalance)

o       70% recovery rate

o       Takes about 6-7 years for recovery

BULIMIA NERVOSA: criteria

o       Binge eating (large amount of intake, feeling of lack of control)

o       Compensatory behavior (vomiting, laxatives, fasting, exercise)

o       Self-evaluation in influenced by body

-          Purging Type

o       During episodes, individual purges

-          Non-purging type

o       No use of purging, but still engages in compensatory activities

-          Sever guilt following bingeing prompts compensatory behaviors

-          90% are females

-          1-3% of women

-          .1-.3% of men

-          Lower mortality rate than anorexia

-          70% recovery rate, although 10% remain fully symptomatic

Anorexia: Fear

Bulemia: Guilt

SCHIZOPHRENIA AND OTHER PSYCHOTIC DISORDERS: symptoms

o       Delusions

o       Hallucinations

o       Disorganized speech

o       Disorganized or catatonic behavior

SCHIZOPHRENIA: Positive symptoms (5)

o       Presence of inappropriate behaviors

o       Hallucinations (false sensory perceptions)

o       Delusions (false beliefs)

o       Bizarre behavior

o       Disorganized ideas (flight of speech)

SCHIZOPHRENIA: Negative Symptoms

o       Absence of appropriate behaviors

o       Flattened emotions

o       Lack of energy

o       Changes in speech

SCHIZOPHRENIA: Criteria (3)

o       2 symptoms for majority of 1 month

o       Negative symptoms for 6 months

o       Symptoms must cause dysfunction

HALLUCINATIONS

-          False sensory perceptions

o       Seem very real

-          Hearing voices

o       Most common

-          Seeing things

-          Feeling things

-          Smelling/tasting things

DELUSIONS

-          Erroneous beliefs

o       Misinterpretation of perceptions or experiences

§         Persecutory

§         Referential

§         Somatic

§         Religious

§         Grandiose

Dillusion theme: Persecutory

  Paranoid type: Schizo

o       Delusions of persecution

§         People are out to get me

-          Delusions of grandeur: Schizo.

o       I’m worth persecuting

o       I’m the president

-          Catatonic type: Schizo

Def:    unusual postures maintained for long periods of time

o       Excessive motor activity

o       Can alternate between stupor and excess

-          Disorganized Type: Schizo

o       Behavior is erratic and disorganized

o       No goal-orientation

o       Incoherent speech

o       Inappropriate emotional responses

SCHIZOPHRENIA: Prevelance & Onset & Gender diff.

-          1% prevalence rate

-          Median age of onset:

o       Mid- 20s for men

o       Late- 20s for women

-          More common in men than women

-          Higher incidence among urban-born individuals

ETIOLOGY OF SCHIZOPHRENIA

-          Genetics

o       48 in identical twins

o       17% in fraternal twins

o       46% in children w/ 2 schizophrenic parents

-          1^st degree bio relative have 10 times higher risk for Schiz.

o       Genetics contribute a vulnerability

o       Possible dopamine problem

o       Amphetamines produce schizophrenic-like states

§         Increase in dopamine

-          Drugs that dampen dopamine activity help schizophrenic symptoms

-          The brain and Schizophrenia

o       Structural problems in prefrontal cortex

§         Speech, decision making

§         Reductions in gray matter

o       Enlarged ventricles

PERSONALITY DISORDERS

-          Disorders characterized by deeply ingrained, inflexible patterns of thinking, feeling or relating to others that impair social functioning

o       Schizotypal, paranoid, schizoid

Schizotypal

·         Strikingly odd or strange, magical thinking, inappropriate affect

 Paranoid

·         Suspiciousness, reluctant to confide, hostil

Schizoid

-          DRAMATIC-IMPULSIVE CLUSTER (4)

o       Anti-social, borderline, histrionic, narcissistic

ANXIOUS-INHIBITED CLUSTER (3)

ANTISOCIAL PERSONALITY DISORDER (4 components)

-          Most troubling and interpersonally destructive

o       Exhibit little anxiety or guilt

o       Can appear credible/charming, but underneath are hostile

o       Impulsive

-          Unstable and intense relationships (love them one day, hate them the next)

-          Unstable self-image

-          Constant state of crisis

-          Want to avoid abandonment

-          Impulsive behaviors

o       Eager to cooperate, seek attention

o       Exaggerate thoughts and feelings- more important

o       Temper tantrums to gain attention, center of attention

o       Seductive behavior

-          Heightened sense of self-importance and grandiose feelings of uniqueness

-          Preoccupied w/ fantasies of power, success and beauty

-          Lack empathy

-          Arrogant

AVOIDANT-INHIBITED CLUSTER

o  Socially withdrawn, extreme sensitivity to rejection, restraint in relationships, avoid activities for fear of rejection or criticism

-          Dependent

o       Chronic illness, look for guidance, fear of being left to take care of self, desires nurturance

-          : Attack of crying, trembling, verbal and physical aggression, fainting episodes, feeling out of control

o       Latin American and Latin Mediterranean

-          fear that the penis will retract into abdomen and kill

-          : Ascribe illness to witchcraft, sorcery, hexing or evil influence of another person

o       Southern US, Caribbean

PHYSIOLOGICAL DISORDERS: 7

-          Anxiety disorders

-          Somatoform

-          Dissociative

-          Mood

-          Eating

-          Schizophrenia

-          Personality

TREATMENT OF PSYCHOLOGICAL DISORDERS

THERAPY

-          15% of US population will seek treatment in a given year

-          Help is sought for everyday problems

o       A client in therapy does not necessarily have a diagnosable disorder

-          Psychologists

o       Ph.D, Psy. D, Ed.D

o       Diagnose physchological disorders

o       Provide therapy for everyday problems to full-fledged disorders

-          Psychiatrists

o       M.D.

o       Diagnose psychological disorders

o       Can prescribe drug therapies

TREATMENTS 5

-          Psychoanalysis

-          Client-centered therapy

-          Behavioral Therapy

-          Cognitive Therapy

-          Biomedical Therapy

PSYCOANALYSIS

-          Aims to recover and resolve unconscious conflicts. Motives and defenses

o       Bring Unconscious into the conscious

o       Interpret and resolve

-          Goal is to bypass resistance

o       Blocking of anxiety-laden information from the conscious mind

-          FREE ASSOCIATION:

-          spontaneous expression of thoughts and emotions as they occur

-          Interpretation of symbolic meaning of one’s dream(s)

-          More prevalent on east coast (guy on couch talking, doesn’t happen as often anymore)

-          : The search for meaning in unconscious material

o       Promote insight in client

-          TRANSFERENCE

o       Client unconsciously starts relating to their therapist in ways that mimic important relationships in their livers

§         EX: Psychologist appears as a maternal figure and client treats her as such

CLIENT-CENTERED THERAPY: define and 3 attributes

-          Supportive approach to therapy to facilitate exploration and client growth (inthe now)

BEHAVIORAL THERAPY & 3 principles

-          Concerned w/ behaviors that individuals exhibit

-          Therapy aims to remove maladaptive behavior

-          PRINCIPLES:

o       Behavior is a product of learning

o       What is learned can be unlearned

o       New, adaptive behaviors can be learned

SYSTEMATIC DESENSITIZATION

-          Associate relaxing state w/ anxiety-triggering stimuli

-          Goal is to weaken bond between stimulus and anxiety response

-          Accomplished through gradual exposure

o       Build anxiety hierarchy

o       Relaxation training

§         Progressive muscle relaxation

·         Recognition of tension in body

§         Breathing Techniques

·         Reduce anxiety by jump starting parasympathetic nervous system

o       Work through hierarchy

-          Creates a negative response to undesirable behaviors

o       EX: treat nail biting by painting nails w/ a bad tasting substance

o       Works to some extent

o       Impeded by cognition

COGNITIVE THERAPY

-          Therapy that teaches people new. More adaptive ways of thinking

-          Corrects habitual thinking disorders fueled be dysfunctional thinking (EX: depression, anxiety)

o       Setbacks are due to personal inadequacies

o       Focus on negatives

o       Pessimistic view of future

o       Negative view of self-based on minor events

Evidence based treatment

BIOMEDICAL THERAPY

-          treatment of mental disorders w/ medication

-          Designed to reduce psychotic symptoms (hallucination, delusions, disorganization)

-          Thorazine, Mellaril. Haldol

-          Reduces Dopamine activity

ANTIANXIETY DRUGS

-          Relieve tension and apprehension and nervousness

-          Valuim, Xanax, BuSpar

-          Depresses central nervous system

-          Fast acting, short-lived relief

ANTIDEPRESSANTS (3 catagories)

o       Tricyclics (eg. Elavil)

o       Monoamine Oxidase (MAO) inhibitors

SSRI’s

SSRI’s

-          Exert effect on 1 NT

o       Serotonin

-          Milder side effects

o       Can still have nervousness, insomnia, sweating, joint pain, sexual dysfunction

o       Reduce depressive symptoms

o       Lower dependence

-          increase the activity of serotonin and norepinephrine

-          MAO: More severe side effects than Tricyclics

o       High blood pressure

o       Weight gain

o       Sexual Dysfunction

ELECTROCONVULSIVE THERAPY (ECT)

-          Brief electric current is sent through the brain causing a cortical seizure and convulsions

-          Originally used for patients w/ schizophrenia, now for severely depressed patients

o       Reduces risk for suicide

o       Works immediately

o       60-70% of people improve

o       Relapse rate is high

INTERPERSONAL THERAPY AND MEDICATION

-          MOST effective

MEDICATION ALONE

-          2^nd MOST effective

INTERPERSONAL THERAPY AND PLACEBO

-          2^nd least effective

PLACEBO MEDICATION ALONE

-          LEAST EFFECTIVE

INSTITUTIONAL TREATMENT IN TRANSITION

-          Patients originally jailed or left to wander

-          State-funded mental hospitals began in the 1840s

-          Mental Hospitals in the 1950s

o       Underfunded

o       Overcrowded

o       Understaffed

o       Hospitals were located far from cities- uprooting people

COMMUNITY MENTAL HEALTH MOVEMENT

            1960s

-          Transferred treatment of mentally ill from inpatient institutions to community-based facilities (outpatient care)

-          POSITIVE: less distribution for individuals. Effective treatment in community

-          NEGATIVE: many patients were released w/ no where to go!! No skills, no family, some communities had no assistance available

ABNORMAL BEHAVIOR: 3 components

o       Personal distress

o       Deviant

o       Dysfunction/maladaptive behavior

-          Learned by classical conditioning: maintained through operant conditioning, biologically disposed to fear certain things

-          Negative mood

- Anhedonia

Cognitive symp.

Motivation symp.

Somatic symp.

1 in 5 Americans suffer from a diagnosable mental disorder

50 % have a diagnosable mental illness at some point in their lifetime

Mental disorders account for 4 out of the top 10 causes of disability in America

·         Distress

o       To individual or others

·         Dysfunction/Maladaptive Behavior

o       Interfere with daily living

o       Both for individual and society

·         Deviance

o       Regulated by societal norms

o       Homosexuality disorder until 1973

degree of vulnerability for a psychological disorder given a sufficient stressor

All behavior is a result of interaction between nature nurture and personal factors

·         May have genetic predisposition to a disporder, but never develop disorder

should be done by a mental health professional, some ground rules for this chapter

·         Don’t diagnose yourself: Med student syndrome

·         Don’t diagnose others

DSM-IV-TR: Diagnostic and Statistical Manual of Mental Disorders

·         Five Axes

o       Axis 1: Clinical syndromes

o       Axis 2: Personality Disorders or Mental retardation

o       Axis 3: General Medical Conditions

o       Axis 4: Psychosocial and environmental problems

o       Axis 5: Global assessment of functioning

Anxiety Disorders

·         tension and apprehension

o       Natural with perceived threats

·         frequency and intensity of anxiety are out of proportion to situation

o       Interferes with daily life

4 Components to anxiety/ define

·         emotional: dread, fear, stressed out, tension

·         cognitive: “I cant cope”

·         physiological: high HR and BP

·         behavioral: avoidances, poor performance

·         7.2-11.3% lifetime prevalence rate

·         Women to Men 2:1

·         Onset: Children

chronic state of overall anxiety, not attached to specific situations

·         Restlessness, easy fatigue, irritability, muscle tension, sleep disturbance, inattention

·         5% prevalence in population

·         More common in women

can occur in anxiety disorder

·         Discrete bouts of panic that occur suddenly reaches peak within 10 mins and eventually pass

·         High heart rate, sweating , trouble breathing, feeling going crazy, fear of dying, trembling, chest pain, etc

Panic Attacks occur repeatedly & unexpectedly, Prev: 3.5%

Onset: late adult--mid 30s

Women

Obsessions, repeated and unwelcome

LTP: 2.5%

Onset: adult-- early adulthood

BOTH genders

Post Traumatic Stress Disorder: LTP, Onset, Gender/ppl

Psychological disturb. attributed to experience of a major traumatic event w/ occurign flashbacks

Onset:anytime

LTP: 8%

1/4 Veterans, 2/3 POWs

Etiology of Anxiety Dissorders

A: Classical cond.

M: Operant cond.

Prep: biologically predisposed to fear certain stimuli

Physical Complaints or dissabilities that suggest a medical prob. w/ no biological cause

Onset: by 25

LTP: Males <.2%, Females .2-2%

Characterized by combo. of pain, gastro. intestinal, sexual impaired coordin. of balance

Onset: by 25

LTP: .2-2%

WOMEN

Loss of phys. function w/ no organic basis; preceeded by conflict

Onset: early adult

LTP: 1-14%

WOMEN

Preoccupation w/ fears of having or ideas of having a serious disease; missinterpretation of symptoms

Onset: early adulthood

LTP: 1-5%

NO GENDER DIFF

• – research gathers data that is easily expressed in numbers