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Psychological Disorders and Their Treatment

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Title: Psychological Disorders and Their Treatment


1
Chapter 11 Psychological Disorders and Their
Treatment
2
Prevalence of Psychological Disorders
  • In a year in the U.S.
  • 20 of persons experience psychological problems
    severe enough to adversely affect their daily
    living.
  • 40 of persons experience at least mild mental
    health problems.
  • About 2.1 million people are admitted to
    hospitals due to serious psychological problems.
  • Worldwide
  • About 400 million people are afflicted with
    psychological disorders.

3
How Should We Understand Psychological Disorders?
  • The medical model proposes that psychological
    disorders have a biological basis and can be
    classified into discrete categories and are
    analogous to physical diseases.

4
How Should We Understand Psychological Disorders?
  • Although not agreeing that all mental health
    problems have a biological basis, mainstream
    psychology has adopted the medical models
    terminology.
  • Symptom a sign of a disorder
  • Diagnosis distinguishing one disorder from
    another
  • Etiology a disorders apparent causes and
    developmental history
  • Prognosis prediction about the likely course of
    a disorder

5
Defining Psychological Disorders
  • A pattern of atypical behavior
  • Results in personal distress or
  • Significant impairment in a persons social or
    occupational functioning

6
Defining Psychological Disorders
  • Major criteria used to differentiate normal from
    disordered behavior
  • Atypical
  • Significantly above or below the average in its
    frequency of occurrence
  • Violates cultural norms
  • Maladaptive
  • Interferes with ability to perform normal
    activities
  • Causes personal distress
  • Individuals who report experiencing troubling
    emotions are often considered to have
    psychological problems.

7
Numerous Theoretical Explanations
  • Five primary perspectives to understand mental
    illness
  • Psychodynamic Disordered behavior is controlled
    by unconscious forces shaped by childhood
    experiences.
  • Behavioral Disordered behavior is caused by
    identifiable factors in the persons environment
    and results from learning.
  • Cognitive ineffective or inaccurate thinking is
    the root cause of mental illness

8
Numerous Theoretical Explanations
  • Five primary perspectives to understand mental
    illness
  • Sociocultural Mental illness is the product of
    broad social and cultural forces .
  • Biological Disordered behavior is caused by
    biological conditions, such as genetics, hormone
    levels, or neurotransmitter activity in the
    brain.

9
Combined Models
  • Diathesis-stress model a predisposition to a
    given disorder (diathesis) that combines with
    environmental stressors to trigger a
    psychological disorder
  • Bio-psycho-social model. Takes into account
    predispositions, personal experience, and life
    circumstances.

10
The Diathesis-Stress Model
11
Psychological Disorders
  • Bio-psycho-social Perspective
  • assumes that biological, sociocultural, and
    psychological factors combine and interact to
    produce psychological disorders

12
Models from Outside Psychology
  • Spirit Possession
  • Trephining
  • Lunacy
  • Curses
  • Family/generational
  • Occult (voodoo, witchcraft)
  • Sin
  • Guilt
  • Unforgiveness, bitterness

13
Risks of Using Diagnostic Labels
  • David Rosenhan demonstrated diagnostic labels
    biasing effects.
  • Misdiagnosis of insanity by hospital personnel
    due to their bias toward calling a healthy person
    sick
  • Diagnostic labels can harm patients in several
    ways.
  • Label may dehumanize patients by encouraging
    mental health practitioners to treat them as
    labels rather than as unique individuals with
    problems.
  • Labeled individuals may experience discrimination
    and may cause people to expect those labeled to
    behave abnormally and thus to misperceive normal
    behavior as disordered.

14
Benefits of Using Diagnostic Labels
  • Despite ethical concerns, diagnostic labels are
    used because they serve several important
    functions
  • Summarize patients symptoms or problems, and
    thus, communicate great deal of information with
    a single word
  • Convey information about possible causes of the
    disorder
  • Convey information about the patients prognosis

15
DSM Classification System
  • Diagnostic and Statistical Manual of Mental
    Disorders (DSM) use to diagnose mental disorders
  • Published by the American Psychiatric
    Association.
  • Since 1980, DSM has been updated several times
    and is now in its fourth edition, text revision,
    or DSM-IV-TR.

16
DSM Classification System
  • DSM classification system is descriptive rather
    than explanatory, meaning that
  • it is not based on a particular theory concerning
    the cause(s) of psychological disorders.
  • diagnoses are based mainly on observable
    symptoms.
  • DSM provides clearer directions concerning
    number, duration, and severity of symptoms
    necessary to assign a diagnosis.
  • By recognizing that two patients with same
    disorder may substantially differ from one
    another, clinicians much more likely to
    acknowledge uniqueness of all patients.

17
Anxiety Disorders Distressing, Persistent
Anxiety, Maladaptive Behavior
  • Characterized by distressing, persistent anxiety
    or maladaptive behavior
  • About 25 percent of the population will
    experience this disorder in our lifetime.
  • Anxiety disorders occur across the life span and
    commonly co-occur with many other disorders, such
    as depression and substance abuse.

18
Anxiety Disorders Distressing, Persistent
Anxiety, Maladaptive Behavior
  • Five major anxiety disorders
  • Panic disorder brief episodes of intense anxiety
    with no apparent reason
  • Phobic disorder strong irrational fears of
    specific objects or situations, called phobias
  • Generalized anxiety disorder (GAD) a constant
    state of moderate anxiety

19
Anxiety Disorders Distressing, Persistent
Anxiety, Maladaptive Behavior
  • Five major anxiety disorders
  • Obsessive-compulsive disorder repetitive,
    unwanted, and distressing actions and/or thoughts
  • Post-traumatic stress disorder occurs among
    individuals who have experienced or witnessed
    traumatic events
  • Later reexperience the event through nightmares,
    flashbacks, and avoid situations or persons that
    trigger flashbacks

20
Anxiety Disorders
21
Anxiety Disorders
  • PET Scan of brain of person with obsessive/
    compulsive disorder
  • High metabolic activity (red) in frontal lobe
    areas involved with directing attention

22
Etiology of Anxiety Disorders
  • Genetic and biological factors
  • Genetic heritage may predispose us to more easily
    develop phobic reactions or to respond intensely
    to stressful events.
  • Behavioral or conditioning factors
  • Classical conditioning may instill conditioned
    emotional responses, and operant conditioning may
    reinforce and maintain the persons avoidance
    responses.
  • Cognitive factors
  • People suffering from panic disorder closely
    monitor their physiological reactions, and often
    exaggerate the significance of their
    physiological symptoms.

23
Mood Disorders Emotional Extremes
  • Characterized by emotional extremes that cause
    significant disruption in daily functioning.
  • To qualify as a mood disorder, emotional extremes
    must persist for a long time.
  • Most common mood disorder is depression
  • Characterized by extreme and persistent negative
    moods and the inability to experience pleasure by
    participating in activities one previously
    enjoyed (Kramlinger, 2001)

24
Mood Disorders Emotional Extremes
  • Depressed individuals
  • Often experience physiological problems such as
    lack of appetite, weight loss, fatigue, and sleep
    disorders
  • Often experience behavioral symptoms, such as
    slowed thinking and acting, social withdrawal,
    and decreased activity
  • Exhibit cognitive symptoms, such as low
    self-esteem, thinking about death and/or suicide,
    and having little hope for the future

25
Mood Disorders-Depression
  • The vicious cycle of depression can be broken at
    any point

26
Mood Disorders-Depression
27
Mood Disorders Emotional Extremes
  • Bipolar disorder characterized by swings between
    the emotional extremes of mania and depression
  • Less common than major depressive disorder,
    occurring in about 1 percent of the population
  • Unlike major depression, this disorder occurs
    about equally in men and women and tends to occur
    earlier than major depression

28
Mood Disorders Emotional Extremes
  • Bipolar disorder
  • Bipolar patients depressive episodes differ from
    the depressive episodes in major depression in
    that they tend to be more severe, are accompanied
    by higher suicide risks, and have a distinct
    pattern of brain activity during sleep.

29
Mood Disorders-Bipolar
  • PET scans show that brain energy consumption
    rises and falls with emotional swings

30
Suicide
  • A major danger of depression is suicide.
  • As many as 30 of people with severe mood
    disorders die from suicide.
  • In the U.S. suicide rates are higher among
  • Men than women
  • Elderly adults than younger adults
  • Unemployed ( retired) adults than employed
    persons
  • Widowed adults than married adults
  • Native European Americans than Asian. Hispanic,
    and African Americans.

31
Etiology of mood disorders
  • Genetic/ biological influence?
  • Bipolar patients show imbalances in neural
    circuits using serotonin, norepinephrine, etc.?
    Enlarged amygdala?
  • Major depressive disorder Family, twin, and
    adoption studies indicate at least a moderate
    genetic influence on depression.
  • Cognitive contributions
  • Depressed persons have negative views and they
    misinterpret daily experiences so that their
    negative outlook is supported.
  • Behavioral psychologists propose that depression
    results from low social reinforcement.

32
Gender Mood Disorders
  • Why is depression more common among women?
  • May due to biological factors.
  • Sociocultural factors Women have fewer
    educational and occupational opportunities,
    receive less money for their work, and experience
    more violence due to their gender than men.
  • Difference in diagnosis?
  • Women may be diagnosed more frequently because
    they are more likely to seek help for their
    problems.
  • Gender bias among mental health professionals may
    result in women and men with identical symptoms
    being diagnosed differently, i.e., women labeled
    as depressed and men diagnosed with other
    conditions

33
Dissociative Disorders Loss of Contact with
Consciousness or Memory
  • Characterized by disruptions in consciousness,
    memory, sense of identity, or perception
  • Dissociative amnesia a sudden loss of memory of
    ones identity and other personal information
  • Dissociative fugue a sudden departure from home
    or work, combined with loss of memory of identity
    and the assumption of a new identity

34
Dissociative Disorders Loss of Contact with
Consciousness or Memory
  • Dissociative identity disorder (DID)
    characterized by the presence of two or more
    distinct identities or personalities, which take
    turns controlling the persons behavior (also
    known as multiple personality disorder)

35
Etiology of Dissociative Disorders
  • Psychodynamic theory results from the
    individuals attempt to repress some troubling
    event
  • Biological explanation patient may have a
    neurological problem that has not yet been
    detected
  • Cognitive perspective individuals learn to
    dissociate as a way to cope with intense distress

36
Schizophrenia Disturbances in Almost All Areas
of Psychological Functioning
  • Characterized by severe impairment in thinking,
    including hallucinations, delusions, or loose
    associations
  • Diagnosed when symptoms persist for at least six
    months, are not due to some other condition, and
    cause significant impairment in daily functioning
  • Schizophrenics often cannot work, manage a home
    or apartment successfully, or care for their
    basic needs.

37
Schizophrenia
  • Delusions
  • false beliefs, often of persecution or grandeur,
    that may accompany psychotic disorders
  • Hallucinations
  • false sensory experiences such as seeing
    something without any external visual stimulus

38
Risk of Developing Schizophrenia
39
Personality Disorders Inflexible Behavior
Patterns That Impair Social Functioning
  • Personality disorders general styles of living
    that are ineffective and lead to problems for the
    person and for others
  • Ten personality disorders in the DSM-IV-TR.

40
Personality Disorders Inflexible Behavior
Patterns That Impair Social Functioning
  • Three common personality disorders are
  • Paranoid personalities habitually distrustful
    and suspicious of others motives
  • Histrionic personalities excessively emotional
    and attention seeking, often turning minor
    incidents into full-blown dramas
  • Narcissistic personalities desire constant
    admiration from others  

41
Personality Disorders Inflexible Behavior
Patterns That Impair Social Functioning
  • The personality disorder that receives the most
    attention is the antisocial personality disorder.
  • Exhibit a persistent pattern of disregard for and
    violation of the rights of others
  • Repeatedly exhibit antisocial behavior across all
    realms of life, lying, cheating, stealing, and
    manipulating others
  • When caught, they take no responsibility and feel
    no remorse.

42
Personality Disorders
Those with criminal convictions have lower levels
of arousal
15 10 5 0
Adrenaline excretion(ng/min)
Nonstressful situation
Stressful situation
No criminal conviction
Criminal conviction
43
Personality Disorders
PET scans illustrate reduced activation in a
murderers frontal cortex
44
Etiology of Personality Disorders
  • A genetic component related to abnormal brain
    development or chronic underarousal of both the
    autonomic and central nervous systems
  • May be caused by the interaction of both
    biological and environmental factors.
  • Children in chaotic households who have a
    biological predisposition for this disorder may
    not learn to control their impulses, and so
    behave in ways to maximize their benefit even if
    this means violating social rules.

45
What Are the Therapies for Psychological
Disorders?
  • The two broad categories of therapy
  • Psychotherapy psychological methods that include
    a personal relationship between a trained
    therapist and a client
  • Biomedical therapies the treatment of
    psychological disorders by altering brain
    functioning with physical or chemical
    interventions

46
What Are the Therapies for Psychological
Disorders?
  • The two broad categories of therapy
  • Psychotherapy psychological methods including a
    personal relationship between a trained therapist
    and a client
  • Biomedical therapies altering brain functioning
    with physical or chemical interventions

47
What Are the Therapies for Psychological
Disorders?
  • Three mental health professions
  • Psychiatry
  • Social work
  • Psychology
  • Two specialty areas in psychology
  • Clinical psychology
  • Counseling psychology

48
Psychodynamic Therapies
  • A group of psychotherapies based on the work of
    Sigmund Freud that say that psychological
    disorders stem from unconscious forces
  • Important psychodynamic terms
  • Free association therapy technique in which
    clients say whatever comes to mind
  • Resistance anything client does to interfere
    with free chain of thought or therapeutic
    progress
  • Transference client transfers feelings for
    significant others early in life to therapist
    (countertransference)

49
Behavior Therapies
  • Psychotherapies that apply learning principles to
    the elimination of unwanted behaviors.
  • Counterconditioning is based on classical
    conditioning.
  • Counterconditioning involves conditioning new
    responses to stimuli that trigger unwanted
    behaviors

50
Counterconditioning Three Techniques
  • Systematic desensitization
  • used to treat phobias in which client is
    gradually exposed to feared object, while
    remaining relaxed
  • Response prevention
  • used to treat obsessive-compulsive disorder
    client is exposed to situation that triggers the
    compulsive behavior but is not permitted to
    engage in the ritual
  • Aversive conditioning
  • a classically conditioned aversive response is
    conditioned to occur in response to a stimulus
    that has previously been associated with an
    undesired behavior

51
Aversive Conditioning for Alcoholism
52
Aversive Conditioning for Alcoholism
53
Aversive Conditioning for Alcoholism
54
Humanistic Therapies Focus on Feelings and
Personal Growth
  • Goal To help people get in touch with
  • their feelings,
  • their true selves
  • their purpose in life

55
Humanistic Therapies Focus on Feelings and
Personal Growth
  • Humanistic therapies help people get in touch
    with their feelings, with their true selves,
    and with their purpose in life
  • Client-centered therapy Carl Rogers
  • Therapists should be facilitators of personal
    growth providing supportive environmentclients
    discover their true selves.
  • Gestalt therapy Fritz Perls
  • Therapists help people become aware of their true
    feelings or some other important aspect of the
    self.

56
Cognitive Therapies Focus on Altering
Dysfunctional Thought Patterns
  • Cognitive therapies seek to identify and then
    modify faulty cognitive processes.
  • Rational-emotive behavior therapy (REBT) Albert
    Ellis
  • Mental distress is caused by the irrational
    thinking people have about those events.
  • Cognitive-behavior therapy (CBT) Aaron Beck
  • Depressed people have negative views of
    themselves, the world, and their future, and they
    misinterpret everyday events to support these
    negative views.

57
Cognitive Therapy
  • Cognitive Therapy
  • teaches people new, more adaptive ways of
    thinking and acting
  • based on the assumption that thoughts intervene
    between events and our emotional reactions

58
Cognitive Therapy
  • The Cognitive Revolution

59
Cognitive Therapy
  • Cognitive-Behavior Therapy
  • a popular integrated therapy that combines
    cognitive therapy (changing self-defeating
    thinking) with behavior therapy (changing
    behavior)

60
Cognitive Therapy
  • A cognitive perspective on psychological disorders

61
Child, Group Family Therapy
  • Child therapies
  • Common approach usedplay therapy
  • Therapist provides children with toys and drawing
    materials
  • Assumption is that whatever is troubling them
    will be expressed in play

62
Child, Group Family Therapy
  • Group therapies
  • Simultaneous treatment of several clients under
    the guidance of a therapist
  • Variation of group therapy is the self-help
    group
  • Several people regularly meeting and discussing
    their problems with one another without the
    guidance of a therapist

63
Child, Group Family Therapy
  • Family and couples therapies
  • Family therapiesdesigned to constructively
    modify the dysfunctional relationships among
    family members
  • Couples therapydesigned to help couples improve
    the quality of their relationship

64
Who Does Therapy?
  • Where do people turn for help?

65
Who Does Therapy?
66
Evaluating Therapy
  • Client Perceptions
  • Consumer Reports Study
  • Clinicians Perceptions
  • Outcome Research
  • Spontaneous Remission
  • Regression toward the mean

67
Does Therapy Work?
  • Meta-analysis
  • procedure for statistically combining the results
    of many different research studies

68
Alternative Therapies
  • Disconnect between Research and Therapy
  • Alternative Therapies
  • Therapeutic touch
  • Eye movement desensitization
  • Light exposure therapy

69
Commonalities among Therapies
  • A new perspective
  • Trusting, caring relationship
  • Culture and values (therapist-client match)

70
Biomedical Therapies
  • Psychopharmacology
  • study of the effects of drugs on mind and
    behavior
  • Lithium
  • chemical that provides an effective drug therapy
    for the mood swings of bipolar (manic-depressive)
    disorders

71
Biomedical Therapies
  • The emptying of U.S. mental hospitals

72
Biomedical Therapies
  • Today in the United States, less than one-third
    the number of people are full-time residents in
    psychiatric hospitals.
  • Reason for this sharp decreasethe widespread use
    of drug therapies in treating psychological
    disorders
  • This form of therapy is often less expensive than
    psychological therapies.

73
Use of Drugs in Treating Psychological Disorders
74
Biomedical Therapies
75
Antipsychotic Drugs Reduce Dopamine Activity
  • Antipsychotic drugs
  • a group of medications that are effective in
    treating the delusions, hallucinations, and loose
    associations of schizophrenia by blocking
    dopamine receptors thereby reducing dopamine
    activity
  • Do not actually cure schizophrenia. They
    merely help control its severe symptoms.

76
Classes of Psychoactive Drugs
  • Antipsychotics
  • Thorazine
  • Clozapine
  • Olanzapine, etc.
  • Block dopamine receptor sites
  • Treat Schizophrenia other psychoses
  • May cause sluggishness muscle tremors

77
Classes of Psychoactive Drugs
  • Antianxiety
  • Valium, Librium, Xanax, etc.
  • Tend to be addictive

78
Classes of Psychoactive Drugs
  • Antidepressants
  • Increase availability of epinephrine or serotonin
  • Prozac, Zoloft, Paxil, etc. worlds most widely
    prescribed drugs
  • Require about a month for full effectiveness

79
Antidepressant Drugs Increase Serotonin and
Norepinephrine
  • MAO inhibitors (MAOI) inhibit the enzyme involved
    in breaking down norepinephrine and serotonin are
    called the monoamine oxidase inhibitors (MAOI).
  • Tricyclics are antidepressant drugs that have
    milder side effects than MAOI inhibitors
  • Antidepressants that affect only serotonin are
    selective serotonin reuptake inhibitors (SSRIs).

80
Biomedical Therapies
  • Electroconvulsive Therapy (ECT)
  • therapy for severely depressed patients in which
    a brief electric current is sent through the
    brain of an anesthetized patient
  • Psychosurgery
  • surgery that removes or destroys brain tissue in
    an effort to change behavior

81
Electroconvulsive Therapy (ECT)
  • A physiological treatment for severe depression
    in which a brief electric shock is administered
    to the brain of an anesthetized patient
  • Although ECT is effective in treating severe
    depression, no one knows for sure why it works.
  • Several temporary negative side effects,
    including confusion, loss of memory, and impaired
    motor coordination

82
Electroconvulsive Therapy
83
Psychosurgery Destroys Portions of the
Brain
  • Most radical controversial treatment
  • A seldom-used surgical procedure in which brain
    tissue thought to cause the disorder is
    destroyed.
  • Today, MRI-guided precision psychosurgery is
    performed only in extreme cases and it focuses on
    much smaller brain areas than those involved in
    lobotomies.

84
Lobotomy
  • now-rare psychosurgical procedure once used to
    calm uncontrollably emotional or violent patients
  • cut the nerves that connect the frontal lobes to
    the emotion-controlling centers of the brain
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