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Title: Myers


1
Myers PSYCHOLOGY (6th Ed--redone 7th)
  • Chapter 16
  • Psychological Disorders
  • James A. McCubbin, PhD
  • Clemson University
  • Worth Publishers

2
David Rosenhan suspected that terms such as
sanity, insanity, schizophrenia, mental illness,
and abnormal might have fuzzier boundaries than
the psychiatric community thought. He also
suspected that some strange behaviors seen in
mental patients might originate in the abnormal
atmosphere of the mental hospital, rather than
the patients themselves.
Education ?AB, Yeshiva College, 1951 ?MA,
Columbia University, 1953 ?PhD (psychology),
Columbia University, 1958 Professor, Stanford
University
3
Dangers of Labeling
David Rosenhan?Being Sane in Insane Places In
1973 sociologist David Rosenhan designed a clever
study to examine the difficulty that people have
shedding the "mentally ill" label. He was
particularly interested in how staffs in mental
institutions process information about patients.
  • Rosenhan seven associates had themselves
    committed to different mental hospitals
    complaining of hearing voices. All but one were
    diagnosed as schizophrenic.
  • Once admitted, they acted totally normal.
  • Remained hospitalized for average 19 days (9 to
    52)
  • Only the patients detected their sanity
  • When discharged their chart read, schizophrenia
    in remission

No professional staff member at any of the
hospitals ever realized that any of Rosenhans
pseudopatients was a fraud.
4
According to a study conducted by the National
Institute of mental health 15.4 of the
population suffers from diagnosible mental health
problems 56 million Americans meet the criteria
for a diagnosible psychological disorder (Carson
1996, Regier 1993) Over the lifespan, /- 32 of
Americans will suffer from some psychological
disorder. (Regier1988)
5
Normal or Abnormal?
Not easy task Is Robin Williams normal? Anna
Nicole Smith? Marilyn Manson? Karl Rove? Is a
soldier who risks his life or her life in combat
normal? Is a grief-stricken woman unable to
return to her routine three months after her
husband died normal? Is a man who climbs
mountains as a hobby normal?
6
Some abnormalities are easy Hallucinations
(false sensory experiences) Delusions (extreme
disorders of thinking) Affective problems
(emotion depressed, anxious, or lack of emotion)
CORE CONCEPT Medical model takes a disease
view Psychology model interaction of
biological, mental, social, and behavioral factors
7
SHOW Psych in Film, Ver.2, 33, Patch Adams
8
  • Psychological Disorder
  • a harmful dysfunction in which behavior is
    judged to be
  • atypical- (not enough in itself)
  • disturbing- (varies with time culture)
  • maladaptive- (harmful)
  • unjustifiable- (sometimes theres a good reason)

9
Show THE WORLD OF AbNORMAL BEHAVIOR 1 Looking
at Abnormal Behavior 2 The Nature of Stress
10
  • Carol D. Ryff argues that we must define mental
    illness in terms of the positive. She names 6
    core dimensions
  • Self-acceptance
  • positive attitude towards self
  • multiple aspects of self
  • positive about past life
  • 2) Positive self relations with other people
  • warm, trusting, satisfying interpersonal
    relationships
  • capable of empathy, affection, intimacy
  • 3) Autonomy
  • independent, self-determined
  • able to resist social pressures

11
4) Environmental mastery sense of mastery and
competence makes good use of opportunities creat
es contexts that support their personal needs 5)
Purpose of Life has goals and
directedness feels there is meaning to past and
present life 6) Personal Growth see oneself as
growing and expanding open to new
experiences change in ways that reflect
self-knowledge and effectiveness
12
Historical Perspective
  • Perceived Causes
  • movements of sun or moon
  • lunacy- full moon
  • demons evil spirits
  • Ancient Treatments
  • exorcism, caged like animals, beaten, burned,
    castrated, mutilated, blood replaced with
    animals blood

13
Historical Perspective
  • Hippocrates (400 bc)
  • first step in scientific view of mental
    disturbance.
  • imbalance (excess) among four body fluids called
    humors

Humors Origin Temperament Blood heart sanguine
(cheerful) Choler (yellow bile) liver choleric
(angry) Melancholer spleen melancholy(depressed
)(black bile) Phlegm brain phlegmatic (sluggish)
14
Psychological Disorders
  • Medical Model
  • concept that diseases have physical causes
  • can be diagnosed, treated, and in most cases,
    cured
  • assumes that these mental illnesses can be
    diagnosed on the basis of their symptoms and
    cured through therapy, which may include
    treatment in a psychiatric hospital

15
Psychological Disorders
  • Bio-psycho-social Perspective
  • assumes that biological, sociocultural, and
    psychological factors combine and interact to
    produce psychological disorders

16
Psychological Disorders- Etiology
  • DSM-IV-TR
  • American Psychiatric Associations Diagnostic
    and Statistical Manual of Mental Disorders
    (Fourth Edition)
  • a widely used system for classifying
    psychological disorders
  • presently distributed as DSM-IV-TR (text
    revision)
  • today used as convenient shorthand to avoid
    labeling.

17
  • DSM-IV-TR organizes each psychiatric diagnosis
    into five levels (axes) relating to different
    aspects of the disorder or disability
  • Axis 1 -- Clinical disorders including major
    mental disorders, as well as developmental or
    learning problems. Common disorders in this
    category include depression, bipolar, anxiety,
    ADHD, and schizophrenia.
  • Axis 2 -- Pervasive or personality disorders,
    including mental retardation. Common disorders
    in this category include borderline PD,
    schizotypal PD, narcissistic PD, antisocial PD,
    paranoid PD.

18
  • DSM-IV-TR continued
  • 3) Axis 3 -- Acute medical conditions and
    physical disorders. Common disorders in this
    category include brain trauma, brain injury,
    brain disease..
  • 4) Axis 4 -- Psychosocial and environmental
    factors contributing to the disorder. Common
    factors in this category include a man suffering
    from depression after losing his job, or his wife
    dying, et. al.
  • 5) Axis 5 -- Global Assessment of Functioning or
    Childrens Global Assessment Scale (under 18)

19
Psychological Disorders- Etiology
  • Neurotic disorder (term seldom used now)
  • usually distressing but that allows one to think
    rationally and function socially
  • Freud saw the neurotic disorders as ways of
    dealing with anxiety
  • Psychotic disorder
  • person loses contact with reality
  • experiences irrational ideas and distorted
    perceptions

20
PREPAREDNESS HYPOTHESIS Suggests that we have an
innate biological tendency, acquired through
natural selection, to respond quickly and
automatically to stimulti that posed a survival
threat to our ancestors. (Ohman Mineka, 2001)
This explains why we develop phobias for snakes
and lightening more easily than others.
21
  • ANXIETY DISORDERS
  • MOOD DISORDERS
  • DISSOCIATIVE DISORDERS
  • SCHIZOPHRENIA
  • PERSONALITY DISORDERS
  • BIOPSYCHOSOCIAL DISORDERS
  • SUBSTANCE ABUSE DISORDERS
  • SEXUAL DISORDERS
  • DEVELOPMENTAL (CHILDHOOD) DISORDERS

22
ANXIETY DISORDERS
23
  • PANIC DISORDER w/AGORAPHOBIA
  • GENERALIZED ANXIETY DISORDER
  • PHOBIAS
  • a) simple
  • b) social
  • c) agoraphobia
  • 4) OBSESSIVE-COMPULSIVE DISORDER (OCD)
  • 5) POST TRAUMATIC STRESS DISORDER (PTSD)
  • 6) SOMATOFORM
  • a) hypochondria
  • b) conversion (hysteria)

24
Anxiety Disorders
  • Anxiety Disorders
  • distressing, persistent anxiety or maladaptive
    behaviors that reduce anxiety

25
Anxiety Disorders
1) Panic Disorder marked by a minutes-long
episode of intense dread in which a person
experiences terror and accompanying chest pain,
choking, racing heart, sweating, muscle-spasms,
or other frightening sensations common thinking
patterns include "Im losing control..... "I
feel like Im going crazy..... "I must be having
a heart attack..... "Im smothering and I cant
breathe.....
1a) Panic Disorder w/Agoraphobia fear of
leaving home for fear of having a panic attack
26
2) Generalized Anxiety Disorder person is tense,
apprehensive, and in a state of autonomic nervous
system arousal
Chronic (6 months) unrealistic or excessive
worry about 2 or more elements in ones life.
27
SHOW Psych in Film, Ver 2, 24, Apollo 13
28
3) Phobias a) Simple Excessive, irrational fear
of objects or situations b) Social Persistent
fear of scrutiny by others doing something
humiliating (stage fright or speech phobia) c)
Agoraphobia Fear of being in a place or situation
with no escape. (childhood environments in which
one did not feel safe)
29
Anxiety Disorders
Phobias persistent, irrational fear of a specific
object or situation
Genophobia sex Gynephobia women Ichthyophobia
fish Lutraphobia otters Macrophobia long
waits Medorthophobia erect penis Parthenophobia
virgins Pophyrophobia color purple Somniphobia
sleep Testophobia taking a test
Ablutophobia washing, bathing Acrophobia
heights Algophobia pain Arachibutyrophobia
peanut butter sticking to roof of
mouth Caligynephobia beautiful
women Cleptophobia stealing Demophobia
crowds Ecclesiophobia church Ergophobia work
30
Anxiety Disorders
  • Common and uncommon fears

31
Anxiety Disorders
4) Obsessive-Compulsive Disorder unwanted
repetitive thoughts (obsessions) and/or actions
(compulsions) feel obsessed w/something they do
not want to think about and/or compelled to carry
out some action, often pointlessly ritualistic.
1 in 50 adults has OCD Exact pathophysiologic
process that underlies OCD has not been
established. Research suggests that
abnormalities in serotonin (5-HT) transmission in
the central nervous system are central to this
disorder. Supported by the efficacy of specific
serotonin reuptake inhibitors (SSRIs) in the
treatment of OCD.
32
Anxiety Disorders
33
Anxiety Disorders
  • PET Scan of brain of person with Obsessive/
    Compulsive disorder
  • High metabolic activity (red) in frontal lobe
    areas involved with directing attention

34
Good examples of obsessions and their closely
related compulsions
Obsession A young woman is continuously
terrified by the thought that cars might careen
onto the sidewalk and run over her. Compulsion
She always walks as far from the street pavements
as possible and wears red clothes so that she
will be immediately visible to an out-of-control
car.
Obsession A mother tormented by concern that she
might inadvertently contaminate food as she cooks
dinner. Compulsion Every day she sterilizes all
cooking utensils in boiling water and wears
rubber gloves when handling food
Obsession A woman cannot rid herself of the
thought that she might accidentally leave her gas
stove turned on, causing her house to
explode Compulsion Every day she feels the
irresistible urge to check the stove exactly 10
times before leaving for work.
35
5) Post Traumatic Stress Disorder (PTSD) Follows
a psychologically distressing event that is
outside the normal experience (rape, war, murder,
beatings, torture, natural disasters)
1 in 12 adults in the U.S. suffer from
PTSD incessant reliving of event, recurring
dreams, intrusive memories, flashbacks, intensive
fears, sleep problems. lasting biological
effects causes the brains hormone-regulating
system to develop hair-trigger responsiveness
Perpetration-induced traumatic stress
(PITS) soldiers who had killed in combat were
found to suffer higher rates of PTSD than other
troops other studies include grief, survivors
guilt, fear
p341 Zim
36
6) Stockholm Syndrome Follows a psychologically
distressing event that is outside the normal
experience (rape, war, murder, beatings, torture,
natural disasters)
captor threatens to kill and is able to do
so victim cannot escape or life depends on the
captor victim is isolated from outsiders captor
is perceived as showing some degree of
kindness victim denies anger at abuser focuses
on good qualities fight or flight reactions
are inhibited victim fears interference by
authorities--fears the captor will return from
jail victim is grateful to abuser for sparing
her life
Example of this disorder would be Francine Hughes
(The Burning Bed) Francine set fire to her
husband while he was asleep after years of
repeated physical and mental abuse.
37
7) Somatoform Disorders
Disorders, involving physical complaints for
which no organic basis can be found.
a) Hypochondria Fear of having serious disease
where no evidence of illness can be found. b)
Conversion (hysteria) Physical malfunction or
loss of bodily control w/no underlying pathology
but apparently related to psychological conflict.
38
TREATMENTS Medical model antianxiety drugs
(valium, librium, xanax) Psychoanalysis
observational learning, childhood (mom/dad), free
association, resistance (transference) Learning
Theories classical conditioning,
counterconditioning, systematic
desensitization Behaviorists principles of
learning, aversive conditioning, operant
conditioning (token economy) Cognitive
Therapies irrational interpretations Humanistic
client-centered therapies, responsibility,
active-listening.
39
MOOD DISORDERS (Affective Disorders)
40
  • DEPRESSIVE DISORDERS
  • a) major depression
  • b) dysthymia
  • 2) BIPOLAR DISORDER
  • a) mania
  • b) major depression
  • 3) SEASONAL AFFECTIVE DISORDER (SAD)

41
Mood Disorders
Mood Disorders characterized by emotional
extremes
  • 1) Depressive Disorders most common disorders
  • a mood disorder in which a person, for no
    apparent reason, experiences two or more weeks of
    depressed moods, feelings of worthlessness, and
    diminished interest or pleasure in most
    activities

a) Major Depressive Disorder Unhappy for 2 weeks
without reason, appetite changes, insomnia,
inability to concentrate, worthlessness,
hallucinations b) Dysthymia Unhappy for over 2
years
42
Aaron Beck is called the FATHER OF COGNITIVE
THERAPY
  • He believed that
  • depressed people draw illogical conclusions about
    themselves.
  • Created the BECK SCALES for labeling clinical
    depression.

Aaron Temkin Beck (1921-?) Professor, Univ
Pennsylvania PhD Brown, Yale
Beck believed that depressed people blame
themselves for normal problems and consider every
minor failure a catastrophe.
43
DRUG TREATMENTS for depression tricyclic
antidepressants first to be used--not used as
much today. affect 2 neurotransmitters
norepinephrine serotonin side affects
drowsiness weight gain, increased heart rate,
decrease in blood pressure, blurred vision, dry
mouth, confusion SSRI (Selective Serotonin
Reuptake Inhibitor) side effects nausea,
diarrhea, tremors, weight loss, headache less
likely to affect the heart some people feel
more agitated and anxious on SSRIs, and can
become increasingly suicidal if not detected and
treated.
44
Mood Disorders
  • 2) Bipolar Disorder
  • a mood disorder in which the person alternates
    between the hopelessness and lethargy of
    depression and the overexcited state of mania
  • formerly called manic-depressive disorder
  • a) Manic Episode
  • a mood disorder marked by a hyperactive, wildly
    optimistic state, excessive excitement,
    silliness, poor judgment, abrasive, rapid flight
    of ideas
  • b) Major depression
  • Lethargic, sleepy, social withdrawal,
    irritability

45
  • Symptoms of Mania
  • Mood or emotional symptoms euphoric, expansive,
    and elevated. In some cases, dominant mood is
    irritability. Even when euphoric, manic people
    are close to tears and if frustrated, will burst
    out crying.
  • Grandiose cognition manics believe no limits to
    their abilities and do not recognize the painful
    consequences of trying to carry out their plans.
    May be delusional about themselves.
  • Motivational symptoms hyperactivity has
    intrusive, dominating, domineering quality. Some
    engage in compulsive gambling, reckless driving,
    or poor financial investment.
  • Physical symptoms lessened need for sleep.
    After a few days, exhaustion settles in.
  • Between .6 and 1.1 percent of U.S. population
    will have bipolar disorder in their lifetime.
  • It affects both sexes equally.
  • Onset is sudden.
  • First episode occurs between ages 20 and 30.

46
Mood Disorders-Bipolar
  • PET scans show that brain energy consumption
    rises and falls with emotional swings

47
Mood Disorders-Depression
48
Mood Disorders-Depression
  • Canadian depression rates

49
3) Seasonal Affective Disorder (SAD) Experience
depression during certain times of the
year usually winter (less sunlight) treated
w/light therapy Alaska (dark for months)
50
Aaron Becks work with depressed patients
convinced him that depression is primarily a
disorder of thinking rather than of mood. He
argued that depression can best be described as a
cognitive triad or negative thoughts about
oneself, the situation or the future.
  • Cognitive errors included the following
  • overgeneralizing drawing global conclusions
    about worth, ability, or performance on basis of
    single fact
  • Selective abstraction focusing on one
    insignificant detail and ignoring others
  • Personalization incorrectly taking
    responsibility for events in the world
  • Magnification minimization bad events
    magnified and good events minimized.
  • Arbitrary inference drawing conclusions without
    sufficient evidence
  • Dichotomous thinking seeing everything in one
    extreme or its opposite.

51
Mood Disorders-Depression
  • Altering any one component of the
    chemistry-cognition-mood circuit can alter the
    others

Generally speaking, a deficit of serotonin is
associated with depression.
52
Mood Disorders-Depression
  • A happy or depressed mood strongly influences
    peoples ratings of their own behavior

53
Mood Disorders-Depression
  • The vicious cycle of depression can be broken at
    any point

54
Mood Disorders-Depression
  • Boys who were later convicted of a crime showed
    relatively low arousal

55
EXAMPLES of Mood Disorders
Andrea Yates postpartum depression and the
insanity plea. It has been suggested that at the
far end of the postpartum psychological spectrum
lie postpartum psychosis. In Andreas case, it
represented a state of mind in which killing
ones children seemed the best way to protect
them.
56
Mood Disorders- Suicide
57
Mood Disorders-Suicide
  • Increasing rates of teen suicide

58
TREATMENTS Medical model For bipolar-- lithium
carbonate, carbamazepine, and valproate. For
depression--tricyclics the newer selective
serotonin re-uptake inhibitors (SSRIs), and
monoamine oxidase inhibitors (MAO inhibitors).
Electroconvulsive therapy (ECT) uses small
amounts of electricity applied to the scalp to
affect neurotransmitters in the
brain. Psychoanalysis Learning
Theories Behaviorists Cognitive Therapies
interpersonal therapy Humanistic
client-centered therapies, responsibility,
active-listening, emotional support and
assistance in recognizing signs of relapse to
avert a full-blown episode
59
DISSOCIATIVE DISORDERS
60
Dissociative Disorders
  • Dissociative Disorders
  • conscious awareness becomes separated
    (dissociated) from previous memories, thoughts,
    and feelings

61
Dissociative Disorders
  • 1) Psychogenic Amnesia
  • Sudden inability to recall important
    information--NOT as a result of physical blow
    or drug-related.

DUE TO EXTREME STRESS!!
  • 2) Psychogenic Fugue
  • Loss of memory--flees to a new location and
    establishes new lifestyle
  • After recovery, events during fugue are not
    remembered

62
Dissociative Disorders
  • 3) Dissociative Identity Disorder
  • rare dissociative disorder in which a person
    exhibits two or more distinct and alternating
    personalities
  • formerly called multiple personality disorder
  • often history of child or sex abuse

In 2008, Herschal Walker, the 1982 Heisman Trophy
winner from the University of Georgia, released
his book Breaking Free which related his
experiences with DID. He reported not being able
to remember winning the Heisman in 1982 or darker
events, such as threatening his then-wife.
63
  • 4) Depersonalization Disorder
  • Persistent, recurring feelings that one is not
    real or is detached from ones own experience or
    body.

64
People with Dissociative Disorders may experience
any of the following
depression, mood swings, suicidal tendencies,
sleep disorders (insomnia, night terrors, and
sleep walking), panic attacks and phobias
(flashbacks, reactions to stimuli or "triggers"),
alcohol and drug abuse, compulsions and
rituals, psychotic-like symptoms (including
auditory and visual hallucinations),
eating disorders headaches, amnesias, time
loss, trances, and "out of body experiences."
self-persecution, self-sabotage violence (both
self-inflicted and outwardly directed).
65
Recent research suggests the risk of suicide
attempts among people with trauma disorders may
be even higher than among people who have major
depression.
Dissociative Disorders are now understood to be
fairly common effects of severe trauma in early
childhood, most typically extreme, repeated
physical, sexual, and/or emotional abuse.
Posttraumatic Stress Disorder (PTSD), widely
accepted as a major mental illness affecting 8
of the general population in the United States,
is closely related to Dissociative Disorders. In
fact, 80-100 of people diagnosed with a
Dissociative Disorder also have a secondary
diagnosis of PTSD
There is evidence that people with trauma
disorders have higher rates of alcoholism,
chronic medical illnesses, and abusiveness in
succeeding generations.
66
TREATMENTS Medical model therapy to recall
the memories, hypnosis or a medication called
Pentothal (thiopental) can sometimes help to
restore the memories Psychoanalysis help an
individual deal with the trauma associated with
the recalled memories. Fugue--Hypnosis.
Dissociative identity disorder-- long-term
psychotherapy that helps the person merge his/her
multiple personalities into one. Learning
Theories Behaviorists Cognitive Therapies
irrational interpretations Humanistic
client-centered therapies, responsibility,
active-listening.
67
SCHIZOPHRENIC DISORDERS (also called Psychotic
Disorders)
68
Schizophrenia literally means split mind,
meaning a split from reality that shows itself in
disorganized thinking, disturbed perceptions and
inappropriate emotions and actions.
The term coined by Emil Kraepelin, who
established the diagnostic category dementia
praecox and Eugen Bleuler, who introduced the
term schizophrenia.
(1857-1939) Medicene, University of Bern
1874, Medicene, Leipzig Wurtzburg, Germany
PSYCHOTIC split from reality
69
Possible symptoms of psychotic illnesses
include Disorganized or incoherent
speech Confused thinking Strange, possibly
dangerous behavior Slowed or unusual
movements Loss of interest in personal
hygiene Loss of interest in activities Problems
at school or work and with relationships Cold,
detached manner with the inability to express
emotion Mood swings or other mood symptoms, such
as depression or mania
70
  • CAUSES
  • chemical imbalances (mad as a hatter)
  • excess D4 dopamine receptors (in autopsies)
    (drugs that block dopamine receptors lessen the
    symptoms)
  • now researching neurotransmitter glutamate
    (direct neurons to pass along an impulse)
  • abnormal brain activity low in frontal lobes
  • research shows (during hallucinations) increased
    activity in thalamus, amygdala, and cortex
  • greater than normal cerebral cortex tissue loss
    between ages 13 and 18.
  • genetics enlarged, fluid-filled cranial cavities

71
Identical Twin studies show 48 probability of
having schizophrenia if your twin does. single
placenta 6 in 10 chance separate placentas 1
in 10 chance one study showed the older the
father, the greater risk of schizophrenia in
offspring
The GENAIN QUADRUPLETS (b.1930) were monozygous
woman all suffered from schizophrenia,
demonstrating a large genetic component to the
disease. The girls (Nora, Iris, Myra, Hester)
were fictitiously named for NIMH (National
Institute of Mental Health). Both parents had
mental disorders during their lifetime.
72
A common finding in the brains of people with
schizophrenia is larger than normal lateral
ventricles.
73
DIATHESIS-STRESS HYPOTHESIS The idea that
biological factors may place the individual at
risk for schizophrenia (or others), but
environmental stressors transform this potential
into an actual disorder.
74
  • DISORGANIZED
  • CATATONIC
  • PARANOID
  • UNDIFFERENTIATED
  • RESIDUAL
  • 6) PARANOID DELUSIONAL DISORDER

75
  • DISORGANIZED SCHIZOPHRENIC
  • confused and incoherent,
  • jumbled speech
  • emotionless or flat or inappropriate, even silly
    or childlike. (flat affect or lack of affect)
  • disorganized behavior that may disrupt their
    ability to perform normal daily activities
    (showering or preparing meals)
  • hallucinations and delusions

76
Disorganized speech is of two types NEOLOGISMS
new words WORD SALAD disorganization
I had belly bad luck and brutal and outrageous.
(I have stomach problems and dont feel good) I
gave all the work money. (I paid tokens for my
meal) I was raised in packs (with other people)
and since I was in littlehood (little girl) she
blamed a few people with minor words (she scolded
people).
The lion will have to change from dogs into cats
until I can meet my father and mother and we
depart some rats. I live on the front part of
Whittons head. You have to work hard if you
dont get into bed. She did. She said,
Hallelujah, happy landings. Its all over for
a squab true tray and there aint not squabs,
there aint no men, there aint no music, there
aint no nothing besides my mother and my father
who stand alone upon the Island of Capri where
there is no ice, there aint no nothing but
changers, changers, changers.
77
  • 2) CATATONIC SCHIZOPHRENIC
  • Physical symptoms
  • immobile and unresponsive to the world around
    them
  • very rigid and stiff, unwilling to move
  • waxy flexibility
  • occasional grimacing or bizarre postures.
  • might repeat a word or phrase just spoken by
    another person.
  • increased risk of malnutrition, exhaustion, or
    self-inflicted injury.

Catatonic excitement patients become agitated
and hyperactive.
78
  • 3) PARANOID SCHIZOPHRENIC
  • preoccupied with false beliefs (delusions) about
    being persecuted or being punished by someone
  • thinking, speech and emotions, however, remain
    fairly normal.
  • the paranoid delusions of persecution or
    grandiosity (highly-exaggerated self-importance)
    are less well organized--more illogical--than
    those of the patient with purely delusional
    disorder.
  • delusions are usually auditory

79
4) UNDIFFERENTIATED SCHIZOPHRENIC diagnosed
when the person's symptoms do not clearly
represent one of the other three subtypes.
  • 5) RESIDUAL SCHIZOPHRENIC
  • suffered from schizophrenia in the past but no
    hallucinations or delusions
  • mildly disturbed thinking
  • emotionally impoverished

80
  • 6) PARANOID DELUSIONAL DISORDER
  • characterized by non-bizarre delusions in the
    absence of other mood or psychotic symptoms
  • delusions involving real-life situations that
    could be true, such as being followed, being
    conspired against or having a disease
  • delusions persist for at least one month.
  • non-bizarre refers to situations such as being
    followed, being loved, having an infection, or
    being deceived by ones spouse
  • needs to be evaluated with respect to religious
    and cultural differences.

81
TREATMENTS Medical model Start olanzapine
(Zyprexa), quetiapine (Seroquel), risperidone
(Risperdal), or aripiprazole (Abilify).Then
chlorpromazine, fluphenazine, and haloperidol.
Last resort Clozapine (Clozaril) (has side
effects) Psychoanalysis medication,
psychological counseling and social
support. Learning Theories Behaviorists
medication, psychological counseling and social
support. Cognitive Therapies Humanistic
medication, psychological counseling and social
support.
82
PERSONALITY DISORDERS
83
1) Paranoid Personality Disorder (PPD) 2)
Obsessive-Compulsive Personality Disorder(OCPD)
3) Antisocial Personality Disorder 4) Borderline
Personality Disorder 5) Schizoid Personality
Disorder 6) Schizotypal Personality Disorder 7)
Narcissistic Personality Disorder
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Personality Disorders
  • Personality Disorders
  • disorders characterized by inflexible and
    enduring behavior patterns that impair social
    functioning
  • usually without anxiety, depression, or delusions

In contrast to other psychological problems,
PDs do NOT want to change. They believe the
problem lies with the other person.
15 of the American population are affected with
personality disorders (Mayo Clinic).46.5 million
people
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About one in seven U.S. adults has at least one
personality disorder, and many have more than one.
Obsessive-compulsive PD 8 Paranoid PD
4.4 Antisocial PD 3.6 Schizoid
PD 3.1 Schizotypal PD 3 Avoidant
PD 2.4 Borderline PD 2 Histrionic
personality disorder 1.8 Narcissistic PD
gt1 Dependent PD gt1
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Personality Disorder Types
  • 1) Paranoid Personality Disorder
  • Belief that others are lying, cheating,
    exploiting or trying to harm you
  • Perception of hidden, malicious meaning in
    benign comments
  • Inability to work collaboratively with
    others
  • Emotional detachment
  • Hostility toward others

CAUSES Might be learned. might be traced back
to childhood experiences. Studies of identical
and fraternal twins suggest that genetic factors
may also play an important role in causing the
disorder. Twin studies indicate that genes
contribute to the development of childhood
personality disorders.
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Personality Disorder Types
  • 2) Obsessive-Compulsive Personality Disorder
  • Excessive concern with order, rules,
    schedules and lists
  • Perfectionism, often so pronounced that you
    can't complete tasks because your standards are
    impossible to meet
  • Inability to throw out even broken,
    worthless objects
  • Inability to share responsibility with
    others
  • Inflexibility about the "right" ethics,
    ideas and methods
  • Compulsive devotion to work at the expense
    of recreation and relationships
  • Financial stinginess
  • Discomfort with emotions and aspects of
    personal relationships that you can't control
    interferes with daily life

Example Howard Hughes
Treatment A physician in this instance is best
sticking with the facts of the presenting problem
and underlying disorder rather than offering
vague impressions of their opinion. Since the
individual with this disorder tends to be
meticulous and concerned with details, the
treatment regimen -- once accepted -- will likely
be adhered to rigorously, without incident.
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Personality Disorder Types
  • 3) Antisocial Personality Disorder
  • Chronic irresponsibility and unreliability
  • Lack of regard for the law and for others' right
  • Persistent lying and stealing
  • Aggressive, often violent behavior
  • Lack of remorse for hurting others
  • Lack of concern for the safety of yourself and
    others
  • Intelligent, charming
  • social skills
  • 75 men
  • Potentially dangerous

Treatment--Because many people who suffer from
this disorder will be mandated to therapy in a
forensic or jail setting, motivation on the
patient's part may be difficult to find. Therapy
should focus on alternative life issues, such as
goals for when they are released from custody,
improvement in social or family relationships,
learning new coping skills, etc. .. part of the
therapy should be devoted to discussing the
antisocial behavior and feelings (or lack
thereof).
Example Hannibal Lecter in Silence of the Lambs
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Although carriers of this personality disorder
are frequently found among street criminals and
con artists, they are also well represented among
successful politicians and business people who
put career, money, and power above everything and
everyone. Two to three percent of the
population in the U.S. may have antisocial
personality disorder. Chronic lying, stealing,
and fighting are common signs. Violations of
social norms begin early in life--disrupting
class, getting into fights, and running away from
home.
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Personality Disorder Types
  • 4) Borderline Personality Disorder
  • Difficulty controlling emotions or impulses
  • Frequent, dramatic changes in mood,
    opinions and plans
  • Stormy relationships involving frequent,
    intense anger and possibly physical fights
  • Fear of being alone despite a tendency to
    push people away
  • Feeling of emptiness inside
  • 75 female

Treatment Dialectical Behavior Therapy teaches
the client how to learn to better take control of
their lives, their emotions, and themselves
through self-knowledge, emotion regulation, and
cognitive restructuring.
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  • 5) Schizoid Personality Disorder
  • Lack of interest in social relations
  • Inability to express feelings
  • Lack of regard for others' opinions
  • Extreme introversion
  • Emotional distance, even from family members
  • Fixation on your own thoughts and feelings

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6) Schizotypal Personality Disorder Egocentricit
y, avoidance of others, eccentricity of
thought Oversensitive frequently see chance
events as related to themselves. Individuals
with this disorder usually distort reality more
so than someone with Schizoid Personality
Disorder. Indifference to and withdrawal from
others "Magical thinking" the idea that you
can influence people and events with your
thoughts Odd, elaborate style of dressing,
speaking and interacting with others Talking
to yourself Belief that messages are hidden
for you in public speeches and displays
Suspicious or paranoid ideas
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Personality Disorder Types
7) Narcissistic Personality Disorder Preoccupied
with receiving attention nurturance Exaggerated
sense of self-importance
Treatment Hospitalization of patients with
severe Narcissistic Personality occurs
frequently, such as those who are quite impulsive
or self-destructive, or who have poor
reality-testing.
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Personality Disorders
  • PET scans illustrate reduced activation in a
    murderers frontal cortex

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Personality Disorders
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TREATMENTS Medical model Psychoanalysis
SchizoidPD--individual therapy (brief),
SchizotypalPD--the clinician must exercise care
to not directly challenge delusional or
inappropriate thoughtswarm, supportive, and
client-centered environment should be established
with initial rapport. Learning
Theories Behaviorists Cognitive Therapies
BorderlinePD--Dialectical Behavior Therapy
teaches the client how to learn to better take
control of their lives, their emotions, and
themselves through self-knowledge, emotion
regulation, and cognitive restructuring. Humanist
ic Group setting (BPD), client-centered
therapies (OCPD), responsibility,
active-listening, NarcissisticPD--Small
staff-patient groups--feelings are shared and
patients' comments taken seriously by staff,
constructive work assignments, recreational
activities, and opportunities to sublimate
painfully conflictual impulses.
There's no cure for these conditions, but therapy
and medication can help. The symptoms of some
personality disorders also may improve with age.
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Biopsychosocial Disorders
  • 4) Anorexia Nervosa (Ch 12, p.454-467)
  • Eating disorder, intense abhorrence of obesity,
    insistance that one is fat
  • Loss of 25 original body fat
  • Refusal to maintain normal weight

5) Bulimia Nervosa (Ch 12, p. 464-467) Unable to
stop eating voluntarily Preoccupation with
weight gain Attempt to lose weight thru binge
eating, self-induced vomiting overuse of
laxatives and diuretics
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A surplus of serotonin is associated with anorexia
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TREATMENTS Medical model viagra Psychoanalysi
s Learning Theories classical
conditioning. Behaviorists Cognitive
Therapies irrational interpretations Humanistic
client-centered therapies, responsibility,
active-listening.
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Rates of Psychological Disorders
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