Mental Illness I: Mood Disorders Anxiety Disorders Somatoform Disorders

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Mental Illness IMood DisordersAnxiety
DisordersSomatoform Disorders

• BCE 548
• Meeting 6
• February 24, 2003

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Mood Disorders

• Mental disorders distinguished by disturbance in
  mood.
• Episodes vs. Disorders
• Episodes are periods in which certain symptoms
  are present are not diagnoses in and of
  themselves.
• Disorders serve as diagnostic categories.
• Mood Episodes Mood Disorders
• Major Depressive Episode Depressive Disorders
• Manic Episode Major Depressive
• Mixed Episode Disorder
• Hypomanic Episode Dysthymic Disorder
• Bipolar Disorders
• Type I
• Type II
• Cyclothymic Disorder

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Mood Episodes

• Three types of mood episodes
• Depression
• Mania
• Hypomania

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Major Depressive Episode

• Symptoms present for at least a week may last
  for weeks/months.
• What is Depression? Symptoms shown in Major
  Depressive Episode include
• Sadness or appearance of sadness
• Easily irritated or angered.
• Loss of interest in activities social
  withdrawal.
• Reduced or increased appetite or craving for
  certain foods.
• Loss of Energy Tires Easily
• Sleep disturbances
• Decreased or agitated psychomotor activity.
• Exaggerated sense of worthlessness, sometimes
  delusional may be accompanied with suicidal
  ideation.
• Difficulty with completing tasks problems with
  concentrating.

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Manic Episode

• Manic symptoms present for at least a week, lasts
  for weeks to months.
• What is Mania? Symptoms shown in Manic Episode
  include
• Euphoria and expansive mood.
• Irritability if intentions are blocked.
• Grandiosity of ideas and exaggerated self-esteem.
• Loud, nonstop speech unresponsive to speech of
  others.
• Thoughts race through the mind.
• Distractibilitycan go off on tangents.
• Extreme pleasure seeking or intense
  goal-directedness with no regard for
  appropriateness of behavior or consequences.
• May Require hospitalization to stabilize the
  individual or protect them from their own actions.

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Hypomanic Episode

• Elevated euphoric state of at least four days (no
  corresponding disorder) lasts for a period of
  weeks or months.
• Symptoms are not as severe as in the Manic
  Episode person can usually function well enough
  to get along socially and vocationally
  (sometimes, they actually function better than
  normal).
• Symptoms are not as exaggerated or bizarre no
  psychotic behavior or delusions.

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Mixed Episode

• Individual shows symptoms of both depression and
  mania (mood swings) for at least a week.
• Symptoms of both Manic Episode and Major
  Depressive Episode must be present each day
  during that week.

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Diagnosis of Mood Disorders

• Major Depression
• Bipolar I Disorder
• Bipolar II Disorder
• Dysthymia
• Cyclothymia

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Major Depressive Disorder

• Diagnosis is applied when an individual has a
  history of one or more Major Depressive Episodes
  with no evidence of Mixed, Manic, or Hypomanic
  Episodes (Depression only).
• One of two types
• Single Episode
• Recurrent
• May be given any of a number of modifiers
  (Post-Partum Onset With Seasonal Pattern)

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Bipolar I Disorder

• History of one or more Manic, Hypomanic, or
  Mixed episodes (Mania by itself or Mania with
  something else).
• Types
• Bipolar I Disorder, Single Manic Episode
• Bipolar I Disorder, Most Recent Episode Hypomanic
  
• Bipolar I Disorder, Most Recent Episode Manic
• Bipolar I Disorder, Most Recent Episode Mixed
• Bipolar I Disorder, Most Recent Episode
  Depressed.
• Bipolar I Disorder, Most Recent type unspecified.

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Bipolar II Disorder

• One or more Major Depressive Episodes together
  with a history of at least one Hypomanic Episode
  (Depression with Hypomania).

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Dysthymic Disorder and Cyclothymic Disorder

• Dysthymic Disorder Depressed mood not severe
  enough for diagnosis of major depression.
• Mood must be depressed for two years (one year
  for children and adolescents) with no
  symptom-free period of more than two months.
• Person cannot have ever had a Manic, Mixed or
  Hypomanic Episode.
• Cyclothymic Disorder Fluctuating mood from mania
  to depression, with symptoms not severe enough
  for diagnosis of bipolar disorder.
• Symptoms must be present for two years with no
  symptom-free period lasting more than two months.

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Treatment/Rehabilitation

• Cause
• Major mood disorders are a result of a
  neurotransmitter imabalance (norepenephrine,
  serotonin).
• Treatment
• Antidepressants (Prozac, Zoloft) and Monomine
  Oxidase (MAO) Inhibitors for Major Depression.
• Lithium for bipolar disorders.
• Electroconvulsive Therapy (ECT)
• Psychotherapy

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Anxiety Disorders

• Disorders brought on by irrational fear, physical
  reactions, or rituals in particular situations or
  in reaction to certain objects.
• Panic Attack/Panic Disorder
• Agoraphobia
• Specific Phobia
• Social Phobia
• Obsessive-Compulsive Disorder
• Post-Traumatic Stress Disorder
• Acute Stress Disorder
• Generalized Anxiety Disorder

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Panic Attacks/Panic Disorder

• Brief periods (lt 10 minutes) of intense fear or a
  sense of doom or feeling of going crazy
  despite an absence of real danger.
• Four of thirteen symptoms must be present for
  diagnosissymptoms may be cognitive or physical
  (see DSM p. 432).
• Desire to flee the situation.
• Panic attacks may occur without stimulus (Uncued
  Attack) or in concert with other anxiety
  disorders (Situationally Bound or
  Situationally Cuedalways occur with a certain
  stimulus Situationally Predisposedoccurring
  in a particular situation but not each time the
  person is in the situation).
• Panic Disorder is the diagnosis that applies to
  recurrent panic attacks and an extended fear (one
  month) that another attack may occur.

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Agoraphobia

• Fear of being in a place in which person is
  trapped, devoid of assistance, or may have a
  panic attack (Panic Attack/Panic Disorder is
  often seen together).
• Some persons develop Agoraphobia without ever
  having had a panic attack
• Some persons are able to venture into
  precipitating environment or situation but do so
  with dread or only with a person they know well.
• Person may become home-bound, does not venture
  outside the home or into an environment over
  which they have total control.
• May become dependent on others for nearly all
  responsibilities related to activities outside
  the home avoid work, social activities.

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Specific Phobia

• Extreme fear of a specific and definable object,
  activity, or situation.
• The fear associated with the phobia may relate to
  impending injury or harm, fear of physical
  reaction associated with an object (such as
  fainting), or fear of a panic attack.
• Five Types
• Animal (e.g., dogs)
• Natural Environment (storms, water, heights)
• Blood-Injection-Injury Type (seeing blood, having
  injections)
• Situational (flying on planes, bridges)
• Other (contracting illness, fear of falling down
  away from walls, choking).

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Social Phobia

• Unreasonable fear of social situations or
  performance situations that are potentially
  embarrassing (public speaking).
• Fear is usually associated with embarrassment at
  public viewing of a physical reaction or feature
  (hand trembling, blushing).
• Diagnosed only if the situation is necessary in
  the persons work or daily routine.
• Generalized Type Individual has unreasonable
  fear in multiple/all social situations.

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Obsessive-Compulsive Disorder

• Presence of obsessions or compulsions that take
  up more than one hour a day or cause marked
  distress or impairment of life activity.
• Obsessions Persistent ideas, thoughts, impulses,
  or images recognized as inappropriate (e.g.,
  bothersome to the person and not related to real
  life problems) and causing marked anxiety or
  distress.
• Compulsions Rituals or actions the individual
  performs to rid themselves of the obsession or
  to make sure that consequences are not realized
  from the obsession (e.g., hand washing)
• Can become so central to an individuals life
  that they are dominated by rituals unable to
  function in work or take care of daily
  necessities.

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Post-Traumatic Stress Disorder

• A set of characteristic symptoms that develop
  following exposure to a physically injurious or
  dangerous situation or witnessing some event
  occur to another that involved a sense of
  helplessness, fear, or horror.
• Symptoms may include
• Psychic revivification (reliving) the event
  (thoughts, dreams).
• Avoidance of stimuli associated with the event.
• Diminished emotional response to the outside
  world (psychic numbing)
• Persistent physical arousal
• Symptoms must last for more than one month and be
  of a severity that interferes with life activity.
• Often caused by military experience, physical or
  sexual assault, disasters and accidents,
  POW/concentration camp experiences, diagnosis of
  life-threatening illness.

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Acute Stress Disorder

• Symptoms similar to Post-Traumatic Stress
  Disorder but not severe enough to cause diagnosis
  of PTSD.

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Generalized Anxiety Disorder

• Excessive anxiety or worry over life events
  present with a person for a period of at least
  six months.
• Person finds it difficult or impossible to
  control the worry.
• Worry is related to ordinary life activities (job
  performance, health of others) but is excessive
  in the context of circumstances.
• Worry is related to some cause not covered by
  another DSM diagnosis (Hypochondriasis, Panic
  Disorder)
• Displays three of the following symptoms
  restlessness, fatigueability, difficulty
  concentrating, irritability, muscle tension,
  disturbed sleep.

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Treatment of Anxiety Disorders

• Psychotherapy works well with many
  disordersoften, cognitive restructuring is
  particularly effective (Rational-Emotive
  approaches).
• Systematic Desensitization Gradually greater
  exposure to a frightening stimulus with
  relaxation therapy employed in specific phobias.
• Behavioral Modeling.
• Antianxiety medicationsBenzodiazapines (Valium),
  Barbituates (phenobarbital), Antihistamines
  (Vistaril).
• Some antidepressants (esp. those that interfere
  with serotonin uptake in the brain) are being
  used to treat Obsessive-Compulsive Disorder
  (Chlomiprimine) and other Anxiety Disorders.

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Somatoform Disorders

• Somatization Disorder
• Undifferentiated Somatoform Disorder
• Conversion Disorder
• Pain Disorder
• Hypochondriasis
• Body Dysmorphic Disorder
• Somatoform Disorder NOS

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Somatoform Disorders

• Psychological Disorders that are manifested in
  physical symptoms or preoccupation with physical
  health or appearance.
• Somatization Disorder
• Undifferentiated Somatoform Disorder
• Conversion Disorder
• Pain Disorder
• Hypochondriasis
• Body Dysmorphic Disorder

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Somatization Disorder

• Also called Hysteria Briquets Syndrome
• Chief Symptom Presence of signs or symptoms of
  physical illness over a period of years either
  out of reason from actual physical illness or
  with no evidence of physical illness whatsoever.
• Disorder must begin before age 30 and should
  cause enough impairment to cause the person to
  have treatment or take medication, or cause
  problems in life activities.
• Diagnosis
• Complaints of pain or dysfunction in four body
  areas/functions
• Two gastrointestinal symptoms other than stomach
  pain.
• One symptom of sexual dysfunction
• One symptom of neurological dysfunction.
• Symptoms must be felt by the person, not faked.

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Somatization Disorder, continued

• In U.S., disorder much more common in women than
  men.
• Symptoms described vividly, exaggerated terms.
• Treatment-seeking behavior often undergo
  numerous dangerous treatments simultaneously.
• Person often also has depression, antisocial
  behavior problems, substance-abuse problems, or
  personality disorders.

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Undifferentiated Somatoform Disorder

• Similar disorder to Somatization Disorder but
  with less symptomatologyperson may show only a
  few physical symptoms not explained by actual
  physical illnessthat persists for at least six
  months.

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Conversion Disorder

• Sensory deficits (blindness, deafness, loss of
  sensation), paralysis of voluntary movement, or
  seizures/tremors with no precipitating physical
  cause. Physical problems are actually present,
  not faked.
• Disorder often develops in response to stress or
  as a response to unpleasant tasks.
• Some persons will be almost indifferent to
  symptoms, while others will be very dramatic,
  hysterical.
• May appear/disappear in response to a particular
  situation (paralysis on the day an individual has
  to sign divorce papers, for instance).

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Pain Disorder

• Complaints of actual pain that have no known
  physical cause. Pain is actually felt by the
  person, not faked.
• Pain must be severe enough to warrant medical
  attention, affect life activities.
• Associated Problems
• Substance Dependency (esp. opioids, pain killers)
• Increased prevalence of depression, suicidal
  ideation.
• Sleep disturbances
• Futile treatment seeking behavior
• Unemployment, disability, financial/family
  issues.

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Hypochondriasis

• Fear that a serious disease is present based upon
  misreading of one or more body signs or symptoms,
  despite medical knowledge that the disease is not
  present.
• May become obsessed with medical information
  Medical Student Syndromemedical students
  become anxious believing they have signs of each
  disease they study.
• Person with hypochondriasis is not reassured by
  clinical tests, talks with physicians.
• May become angry at medical personnel not doing
  enough for them begins to doc hop.
• Tests, treatments can cause physical problems,
  drain financial resources.
• Social relationships are strained as person is
  preoccupied with physical symptoms.
• Person may miss time from work rarely, they may
  become totally incapacitated.

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Body Dysmorphic Disorder

• Preoccupation with an imagined defect of
  appearance or exaggerated concern over a slight
  defect.
• Concern may dominate lifeperson may withdraw
  from activities, work.
• Person may continually inspect the defect in
  windows, mirrors, running hands over it.
  Alternatively, some persons remove mirrors from
  the home and are afraid of looking at the defect.
• Difficult for person to talk specifically about
  the defect rather, they generalize it to the
  whole body (I am ugly.)
• May engage in activities to correct the
  problemexcessive exercise, cosmetic surgery,
  medical treatment (self-surgery in extreme
  cases). However, this rarely alleviates the
  concern even if procedures make improvement in
  appearance.
• Person may become depressed, suicidal, develop
  delusions that people are staring at or talking
  about the defect.

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Treatment of Somatoform Disorders

• Behavioral TherapyNonreinforcement of sick role.
• Social Skills Training, Assertiveness
  TrainingTeaching person to approach life from a
  positive self-image rather than that of weakness,
  sickness.
• Better management of life stressors, anxiety.