Psychopathology

PSYCHOPATHOLOGY DIAGNOSIS AND TREATMENT STRATEGIES

ANXIETY, SOMATOFORM, AND DISSOCIATIVE DISORDERS Disorder

Subtypes

Major Symptoms

Anxiety disorders

Phobias

Intense, irrational fear of objectively nondangerous situations or things, leading to disruptions of behavior.

Generalized anxiety disorder

Excessive anxiety not focused on a specific situation or object; freefloating anxiety.

Panic disorder

Repeated attacks of intense fear involving physical symptoms such as faintness, dizziness, and nausea.

Obsessive-compulsive disorder

Persistent ideas or worries accompanied by ritualistic behaviors performed to neutralize the anxiety-driven thoughts.

Conversion disorder

A loss of physical ability (e.g., sight, hearing) that is related to psychological factors.

Hypochondriasis

Preoccupation with or belief that one has serious illness in the absence of any physical evidence.

Somatization disorder

Wide variety of somatic complaints that occur over several years and are not the result of a known physical disorder.

Pain disorder

Preoccupation with pain in the absence of physical reasons for the pain.

Amnesia/fugue

Sudden, unexpected loss of memory, which may result in relocation and the assumption of a new identity.

Dissociative identity disorder (multiple personality disorder)

Appearance within same person of two or more distinct identities, each with a unique way of thinking and behaving. 2

Somatoform disorders

Dissociative disorders

InRev15a

ANXIETY DISORDERS ◆ ◆ ◆ ◆ ◆

PANIC DISORDER GENERALIZED ANXIETY DISORDER PHOBIAS OBSESSIVE-COMPULSIVE DISORDER POST-TRAUMATIC STRESS DISORDER

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PANIC DISORDER Experience reoccurring episodes of anxiety attacks; unpredictable; some situations might become related to it. Anxiety attack: 5 needed may last a couple of minutes to hours

heart palpitations tense muscles, especially chest muscles often misinterpreted for heart attack, choking sensation from tight neck muscles, faint or dizzy feeling, increase sweat, hot or cold flashes. 4

GENERALIZED ANXIETY DISORDER Persistent level of anxiety lasting at least one month Symptoms: Motor: Tension of muscles: shakes, tremble, unable to relax, twitch, startle easily Autonomic hyperactivity: Sweat, increased heart rate, cold hands, hot, cold flashes, light headed and dizzy Apprehension--worry constantly Vigilance and scanning: hyperattentive to things in the environment, distractible, hard to concentrate, impatient, irritable. 5

PHOBIA Irrational fear response of specific stimuli SOCIAL PHOBIAS AGORAPHOBIA SPECIFIC PHOBIAS

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OBSESSIVE-COMPULSIVE DISORDER Marked by overt ritualistic behavior and persistent intruding thoughts Occurs at a frequency so high as to interfere with daily functioning 7

SOMATOFORM DISORDERS

◆ HYPOCHONDRIASIS ◆ CONVERSION

HYSTERIA

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HYPOCHONDRIASIS Preoccupation with body and illness No relief if given healthy diagnosis Just as tense--travel and search for new physicians

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CONVERSION DISORDER Individual has dramatic physical symptoms with no organic cause. 1. 2. 3. 4.

Paralysis of legs/arms/ total Anesthesia--lost sense of touch with parts of body Analgesia--feel no pain Other common experiences: nausea, lower back pain, dizziness, hysterical blindness, deafness, unexplained headaches 5. Unusually INDIFFERENT to symptoms 6 .Secondary gain for having symptoms 7. May disappear while asleep or under hypnosis 8. Craft Paralysis: symptoms selective to job--paralyzed hands of violinist or tennis player. 9. Symptoms make no common sense neurologically

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DISSOCIATIVE DISORDERS ◆ DISSOCIATIVE

AMNESIA ◆ DISSOCIATIVE FUGUE ◆ DISSOCIATIVE IDENTITY DISORDER

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DISSOCIATIVE AMNESIA Memory for certain events from 1 hour to 3 months is lost Person is not distressed by loss of memory-intellectual and skills still there. Theorized as a loss of memory (repression) for traumatic event

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DISSOCIATIVE FUGUE Amnesia for entire life & self Starts a new life in a new location -called travelling amnesiac Cause: extreme stress & need to flee Can last for days, weeks, years. Extremely rare except on Soaps! 13

DISSOCIATIVE IDENTITY DISORDER Dominance of 2 or more distinct personalities Generally amnesic for existence of others Controversial Diagnosis 14

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Fig131 Precursors

Diathesis

Genetic factors

Stress

Outcome

Poor selfunderstanding

Brain disease Disorder (e.g. schizophrenia)

Vulnerability Early learning experiences

Stressful family dynamics

Bad family dynamics

Social stresses

Diathesis Stress Model of Disorders

AFFECTIVE DISORDERS MAJOR DEPRESSION ◆ DYSTHYMIC DISORDER ◆ BIPOLAR DISORDER ◆ CYCLOTHYMIC DISORDER ◆ SEASONAL AFFECTIVE DISORDER ◆

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CLINICAL DEPRESSION Emotions major disturbing problem but also problem in cognition (self-defeating thoughts) 1. Dysphoric mood for a minimum of 2 weeks plus 4 of following: Change in appetite usually decrease Change in sleep--insomnia or hypersomnia Change in amount of psychomotor activity-slow or agitated Fatigue or loss of energy Feelings of worthlessness, self critical or inappropriate guilt Poor concentration Suicide or suicidal ideation

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BIPOLAR DISORDER MANIC-DEPRESSION Elevated mood-elation and mania alternating with depressive thoughts Mania: inflated self esteem: too self confident talkative w/flight of ideas increased activity, interests, social decreased need of sleep, distracted concern that will harm selves not judge consequences of actions shopping spree--self destructive buying pattern

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INCIDENCE OF DEPRESSION Major depression Bipolar disorder Fig147 80 70 60 50 Risk 40 30 20 10

Prevalence in general population Fraternal twins Identical twins

Prevalence in general population Fraternal twins Identical twins

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Creativity and Madness Artists Paul Gauguin (SA), Vincent van Gogh (H, S), Ern st Ludwig Kirchner (H, S), Edward Lear, Michelangelo, Edvard Meunch (H), Georgia O'Keeff e (H), George Romney, Dante Gabriel Rossetti(SA)

Writers

Poets

Hans Chr istian Andersen William Faulkner (H) F. Scott Fitzgerald (H), ErnestHemingway (H, S), Hermann Hesse (H, SA), Henrik I bsen Henry James William James Samuel Clemens (MarkTwain) Joseph Conrad (SA) Charles Dickens I sak Dinesen (SA) Ralph Waldo Emerson Herman Melville Eugene O'Neill (H , SA) Mary Shelley Robert Louis Stevenson Leo Tolstoy Tennessee Williams (H) MaryWollstonecraft ( SA) Virginia Woolf ( H, S)

William Blake Robert Burn s Lord Byron Samuel Taylor Coleridge EmilyDickinson T.S. Eliot (H) Oliver Goldsmith Gerard Manley Hopkins Victor Hugo Samuel Johnson John Keats James Russell Lowell Robert Lowell (H) Edna St. Vincent Mill ay (H) Bori s Pasternak (H) Sylvia Plath (H, S) Edgar A llan Poe (SA) Ezra Pound (H) Anne Sexton (H, S) Percy Bysshe Shelley (SA) Alfred, Lor d Tennyson, Dylan Thomas Walt Whitman

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SCHIZOPHRENIA PARANOID ◆ CATATONIA ◆ DISORGANIZED HEBEPHRENIA ◆ SIMPLE ◆ RESIDUAL ◆

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SCHIZOPHRENIA Aspect Common Symptoms Disorders of thought

Key Features

InRev15b Disturbed content, including delusions; and disorganization, including loose associations, neologisms, and word salad.

Disorders of perception

Hallucinations, or false perceptions; poorly focused attention.

Disorders of emotion

Flat affect; or inappropriate tears, laughter, or anger.

Possible Causes Biological Psychological

Genetics; abnormalities in brain structure; abnormalities in dopamine systems; neurodevelopmental problems. Learned maladaptive behavior; disturbed patterns of family communication.

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15_05

Fig15_5 C

Max

Schizophrenic behavior

A

Threshold

Challenging events Normal behavior

D B

Min

Low

Vulnerabilit y

High 23

PERSONALITY DISORDERS ANTISOCIAL AVOIDANT

BORDERLINE

DEPENDENT HISTRIONIC

NARCISSISTIC

OBSESSIVE- PARANOID COMPULSIVE

SCHIZOTYPAL

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Fig15_5

Type

Typical Features

Paranoid

Suspiciousness and distrust of others, all of whom are assumed to be hostile.

Schizoid

Detachment from social relationship; restricted range of emotion.

Schizotypal

Detachment from, and great discomfort in, social relationships; odd perceptions, thoughts, beliefs, and behaviors.

Depedent

Helplessness; excessive need to betaken care of; submissive and clinging behavior; difficulty in making decisions.

Obsessivecompulsive

Preoccupation with orderliness, perfection, and control.

Avoidant

Inhibition in social situations; feelings of inadequacy; oversensitivity to criticism.

Histrionic

Excessive emotionality and preoccupation with being the center of attention; emotional shallowness; overly dramatic behavior.

Narcissistic

Exaggerated ideas of self-importance and achievements; preoccupation with fantasies of success; arrogance.

Borderline

Lack of stability in interpersonal relationships, self-image, and emotion; impulsivity; angry outbursts; intense fear of abandonment; recurring suicidal gestures.

Antisocial

Shameless disregard for, and violation of, other people's rights.

Tab15_5

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PSYCHO-SEXUAL DISORDERS Fetishism Zoophilia Sadism Masochism Exhibitionism Pedophilia 26

DEVELOPMENTAL DISORDERS Autism Academic Skills Disorder Attention Deficit Disorder w/hyperactivity Senile Dementia 27

TREATMENT PSYCHOANALYSIS BEHAVIOR HUMANISTIC COGNITIVE BIOMEDICAL

SIGMUND FREUD PSYCHOANALYSIS

Resistance Catharsis Transference Interpretation Insight

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DEINSTITUTIONALIZATION

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APPROACHES TO PSYCHOLOGICAL TREATMENT Dimension

Classical Psychoanalytic

Nature of the human Driven by sexual and being aggressive urges

Contemporary Psychodynamic

Phenomenological Behavioral

InRev16a Driven by the need for human relationships

Has free will, choice, and capacity for selfactualization

A product of social learning and conditioning; behaves on the basis of past experience

Therapist’s role

Neutral; helps client explore meaning of free associations and other material from the unconscious

Active; develops Facilitates client’s growth; relationship with client as some therapists are a model for other active, some nondirective relationships

Teacher/trainer who helps client replace undesirable thoughts and behaviors; active, actionoriented

Time frame

Emphasizes unresolved unconscious conflicts from the distant past

Understanding the past, but focusing on current relationships

Current behavior and thoughts; may not need to know original causes in order to create change

Goals

Psychosexual maturity through insight; strengthening of ego functions

Correction of effects of Expanded awareness, failures of early fulfillment of potential; attachment; development self-acceptance of satisfying intimate relationships

Changes in thinking and behaving in particular classes of situations; better self-management

Typical methods

Free association; dream analysis, analysis of transference

Analysis of transference and countertransference

Systematic desensitization, modeling, assertiveness and social skills training, positive reinforcement, aversive conditioning, punishment, extinction, cognitive restructuring

Here and now; focus on immediate experience

Reflection-oriented interviews designed to convey unconditional positive regard, empathy, congruence; exercises to promote self-awareness

CARL ROGERS CLIENT CENTERED

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HUMANISTIC THERAPY 55

BASIC HUMAN NEEDS

Need for self-actualization

Need for positive regard

OTHERS' RESPONSES Unconditional positive regard

RESULT Self-actualization SELF GUIDES

Conditional positive regard

MENTAL HEALTH EFFECTS

Self = ideals

Sadness Disappointment Depression

Self = oughts

Anxiety Shame Guilt

Selfdiscrepancies

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ROLLO MAY EXISTENTIAL THERAPY

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ALBERT BANDURA MODELING

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BEHAVIOR AND COGNITIVE SY STEM A TI C D ESEN SI TI ZA TI ON F LOOD I N G

I M P LOSI V E

A V ER SI ON

M OD ELI N G R A TI ON A L EM OTI V E ELLI S STR ESS I N N OCU LA TI ON COGN I TI V E --BECK

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BIOLOGICAL TREATMENTS FOR PSYCHOLOGICAL DISORDERS Method

Typical Disorders Treated

Possible Side Effects

Mechanism of Action

InRev16b

Electroconvulsive therapy (ECT)

Severe depression

Temporary confusion, memory loss

Uncertain

Psychosurgery

Schizophrenia, severe depression, obsessivecompulsive disorder

Listlessness, overemotionality, epilepsy

Uncertain

Psychoactive drugs

Anxiety disorders, depression, obsessivecompulsive disorder, mania, schizophrenia

Variable, depending on drug used: movement disorders, physical dependence

Alteration of neurotransmitter systems in the brain

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ELECTRO-CONVULSIVE SHOCK TREATMENT (ECT) ◆

◆ ◆

◆

◆

Single most effective treatment for psychotic depression Used as treatment of last resort Actual understanding of how it works is not complete--disrupts electrical impulses of brain Within two to four weeks many see profound mood elevation Side Effects include memory loss (usually short term)

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PSYCHOSURGERY ◆

PREFRONTAL LOBOTOMY ◆ Removal of brain tissue to relieve symptoms ◆ Pre-frontal lobotomy first used on gorillas and found to calm aggression; applied to patients in mental institutions beginning in the 1950’s ◆ Often used on schizophrenics bringing flat affect ◆ Today smaller amount of tissue can be removed from specific areas showing malfunction--cingulotomy ◆ Can be very effective at removing tumor and other tissue causing abnormal behaviors

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BIOMEDICAL TREATMENTS Drug Treatment Options: ◆ Anti-Anxiety Xanax ◆

◆ GABA

◆

neurotransmitter

Anti-Depressant drugs Prozac ◆ Serotonin

◆

and Norepinephrine

Anti-Psychotic drugs

Thorazine

◆ Dopamine

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Number of people

Average untreated person

Average treated person

80% of untreated persons No improvement

Outstanding improvement

PSYCHOTHERAPY VS NONE

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