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Mental Illness I: Mood Disorders Anxiety Disorders Somatoform Disorders


Agoraphobia. Specific Phobia. Social Phobia. Obsessive-Compulsive Disorder ... Agoraphobia ... Some persons develop Agoraphobia without ever having had a panic attack ... – PowerPoint PPT presentation

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Title: Mental Illness I: Mood Disorders Anxiety Disorders Somatoform Disorders

Mental Illness IMood DisordersAnxiety
DisordersSomatoform Disorders
  • BCE 548
  • Meeting 6
  • February 24, 2003

Mood Disorders
  • Mental disorders distinguished by disturbance in
  • Episodes vs. Disorders
  • Episodes are periods in which certain symptoms
    are present are not diagnoses in and of
  • 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

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

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
  • 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
  • Difficulty with completing tasks problems with

Manic Episode
  • Manic symptoms present for at least a week, lasts
    for weeks to months.
  • What is Mania? Symptoms shown in Manic Episode
  • Euphoria and expansive mood.
  • Irritability if intentions are blocked.
  • Grandiosity of ideas and exaggerated self-esteem.
  • Loud, nonstop speech unresponsive to speech of
  • 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.

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
  • Symptoms are not as exaggerated or bizarre no
    psychotic behavior or delusions.

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.

Diagnosis of Mood Disorders
  • Major Depression
  • Bipolar I Disorder
  • Bipolar II Disorder
  • Dysthymia
  • Cyclothymia

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)

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
  • Bipolar I Disorder, Most Recent type unspecified.

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

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.

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

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

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.

  • 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.

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
  • Situational (flying on planes, bridges)
  • Other (contracting illness, fear of falling down
    away from walls, choking).

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.

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
  • 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

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.

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

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
  • Displays three of the following symptoms
    restlessness, fatigueability, difficulty
    concentrating, irritability, muscle tension,
    disturbed sleep.

Treatment of Anxiety Disorders
  • Psychotherapy works well with many
    disordersoften, cognitive restructuring is
    particularly effective (Rational-Emotive
  • Systematic Desensitization Gradually greater
    exposure to a frightening stimulus with
    relaxation therapy employed in specific phobias.
  • Behavioral Modeling.
  • Antianxiety medicationsBenzodiazapines (Valium),
    Barbituates (phenobarbital), Antihistamines
  • 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.

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

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

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
  • Two gastrointestinal symptoms other than stomach
  • One symptom of sexual dysfunction
  • One symptom of neurological dysfunction.
  • Symptoms must be felt by the person, not faked.

Somatization Disorder, continued
  • In U.S., disorder much more common in women than
  • 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.

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

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,
  • May appear/disappear in response to a particular
    situation (paralysis on the day an individual has
    to sign divorce papers, for instance).

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
  • Sleep disturbances
  • Futile treatment seeking behavior
  • Unemployment, disability, financial/family

  • 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
  • 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.

Body Dysmorphic Disorder
  • Preoccupation with an imagined defect of
    appearance or exaggerated concern over a slight
  • 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
  • Person may become depressed, suicidal, develop
    delusions that people are staring at or talking
    about the defect.

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,
  • Better management of life stressors, anxiety.