PSYCHOPATHOLOGY

PSYCHOPATHOLOGY





DIAGNOSIS

AND

TREATMENT STRATEGIES

ANXIETY, SOMATOFORM, AND DISSOCIATIVE DISORDERS



Disorder Subtypes Major Symptoms



Anxiety

disorders

Phobias

InRev15a

Intense, irrational fear of objectively nondangerous situations or things,

leading to disruptions of behavior.



Generalized anxiety Excessive anxiety not focused on a specific situation or object; free-

disorder floating anxiety.



Panic disorder Repeated attacks of intense fear involving physical symptoms such as

faintness, dizziness, and nausea.



Obsessive-compulsive Persistent ideas or worries accompanied by ritualistic behaviors

disorder performed to neutralize the anxiety-driven thoughts.



Somatoform Conversion disorder A loss of physical ability (e.g., sight, hearing) that is related to

disorders 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.



Dissociative Amnesia/fugue Sudden, unexpected loss of memory, which may result in relocation

disorders and the assumption of a new identity.



Dissociative identity Appearance within same person of two or more distinct identities, each

disorder (multiple with a unique way of thinking and behaving. 2

personality disorder)

ANXIETY DISORDERS



 PANIC DISORDER

 GENERALIZED ANXIETY DISORDER

 PHOBIAS

 OBSESSIVE-COMPULSIVE DISORDER

 POST-TRAUMATIC STRESS DISORDER









3

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









6

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









8

HYPOCHONDRIASIS



Preoccupation with body and

illness

No relief if given healthy

diagnosis

Just as tense--travel and search

for new physicians





9

CONVERSION DISORDER



Individual has dramatic physical symptoms with no organic cause.



1. Paralysis of legs/arms/ total

2. Anesthesia--lost sense of touch with parts of body

3. Analgesia--feel no pain

4. 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







10

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





12

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

56









Fig131

Precursors Diathesis Stress Outcome



Genetic Poor self-

factors understanding





Brain disease

Disorder (e.g.

Vulnerability

schizophrenia)

Early learning Stressful family

experiences dynamics





Bad family

Social stresses

dynamics









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







17

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









18

57









INCIDENCE OF DEPRESSION

80

Major depression

Fig147 disorder

Bipolar



70

60

50

Risk 40

30

20

10





Prevalence in Prevalence in

general population general population

Fraternal twins Fraternal twins

Identical twins Identical twins





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Creativity and Madness

Writers Poets

Ha n s Chr is t ia n An d er sen Willia m Blak e

Artists Willia m Fa u lk ner (H) Rob ert Burn s

Pa u l Ga u gu in ( SA) , F. Scot t Fit zger ald (H) , Lo r d Byr o n

Vince n t v a n G og h (H , S) , Erne stH em in gwa y (H, S) , Sa m u el Tay lo r Col er id ge

Her ma nn Hesse (H, SA) , Emil yD ickin so n

Ern st Lu d wig Ki rchner ( H, S) ,

Hen r ik Ibs en T.S. Eli o t (H)

Ed wa r d Lea r, Henr y Ja me s

Miche la nge lo, Oli ve r Golds m it h

Willia m Jam es

Ger a r d Ma n ley Hop kin s

Ed va r d Meu n ch (H) , Sa m u el Cle m en s ( Ma r kT wa in )

Victo r Hu go

Geo r gia O 'Kee ff e (H ) , Jos ep h Co n ra d ( SA)

Sa m u el Jo hn so n

Geo r ge R om ney , Ch a r les Dicken s

Jo hn Kea ts

Isak Dine sen (SA)

Da nte Ga b r ie l Ro sset t i( SA) Jam es Ru ssell Lo well

Ral ph Wald o Eme r so n

Her m a n M elvill e Rob ert Lo well (H)

Eu gene O'Ne ill (H , SA) Ed n a St . Vincen t Mill ay ( H)

Ma r y Sh elley Bo ri s Pa st ern ak ( H)

Rob ert Lo u is Ste ven so n Sylv ia Plat h (H, S)

Leo Tols t o y Ed g a r A lla n P o e ( SA)

Tenne ssee Wil liam s ( H) Ezr a Po u nd ( H)

Ma ry Wo llsto necr a ft ( SA) An ne Sex to n (H, S)

Vir gin ia Woolf ( H, S) Pe r cy Bysshe She lley ( SA)

Alf re d , Lor d Te n ny so n,

Dy la n Th om a s

Wa lt W h it ma n



20

SCHIZOPHRENIA



 PARANOID

 CATATONIA

 DISORGANIZED HEBEPHRENIA

 SIMPLE

 RESIDUAL









21

22

15_05









Max Fig15_5

C Schizophrenic

behavior



A







Challenging Threshold

events



Normal

behavior D





Min B







Low Vulnerability High





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PERSONALITY DISORDERS





ANTISOCIAL AVOIDANT BORDERLINE





DEPENDENT HISTRIONIC NARCISSISTIC





OBSESSIVE- PARANOID SCHIZOTYPAL

COMPULSIVE





24

Fig15_5

Type Typical Features

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



Schizoid

Tab15_5

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.



Obsessive- Preoccupation with orderliness, perfection, and control.

compulsive



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. 25

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









29

DEINSTITUTIONALIZATION









30

APPROACHES TO PSYCHOLOGICAL TREATMENT

Classical Contemporary

Dimension Psychoanalytic Psychodynamic Phenomenological Behavioral

Nature of the human Driven by s exual and

being aggres sive urges InRev16a

Driven by the nee for

human rela

d

tionships

Has free will, c hoi and

capac ity for self-

n

ac tualizatio

ce, A product of s ocial

g

learnin and condi tioning;

as

behaves on the b is of

past experience



T herapist’s role s

Neutral; help c lient Ac tive; develops t’s

Facilitates clien growth; T eacher/trainer who

explore mea ning of free ip t

relationsh with clienas some therapis ts are n

helps clie t replace

s

as soc iation and other a model for other ac tive, somenondirective ble ts

undes ira though and

material from the relationships behaviors; active, action-

unconscio su oriented



T ime frame res

Emphasizes un olved ing w;

Unders tand the past, Here and no focus on Current behavior and

u

unconscio s conflic ts nt

but foc using on curre erienc e

immediate exp thoughts; may not need

from the distant past relationships al

to know origin causes in

order to create change



Goals Ps ychosexual maturity Correc tion of effec ts of Expanded a wareness, Changes in thinking an d

ght;

through insi failures of early l;

fulfillment of potentia r

behaving in partic ula

g

strengthenin of ego m

attachment; develop ent self-ac ceptanc e classes of situations;

functions of satisfying intimate m

better self-manage ent

relationships



T ypical methods ;

Free associationdream riented

Analys is of transference Reflec tion-o Systematic

l

analys is, anays is of and countertransferen ce interviews de signed to desensitiza g

tion, modelin ,

transference convey uncon ditional d

as sertiveness an s ocial

rd,

positive rega empathy, g

skills trainin, pos itive

congruen ce; exercis es to rein-

promote s elf-awa reness ,

forcement avers ive

condition ing, punis hment,

extinction, cog-

nitive restructuring

CARL ROGERS

CLIENT CENTERED









32

HUMANISTIC THERAPY

55









BASIC HUMAN OTHERS'

NEEDS RESPONSES RESULT



Unconditional Self-actualization

positive regard MENTAL HEALTH

Need for

self-actualization EFFECTS

SELF GUIDES

Sadness

Self = ideals Disappointment

Need for Depression

positive regard

Conditional Self-

positive regard discrepancies

Anxiety

Self = oughts Shame

Guilt









33

ROLLO MAY

EXISTENTIAL THERAPY









34

ALBERT BANDURA

MODELING









35

BEHAVIOR AND COGNITIVE



SYSTEMATIC MODELING

DESENSITIZATION

RATIONAL

FLOODING EMOTIVE

ELLIS



IMPLOSIVE STRESS

INNOCULATION



AVERSION COGNITIVE --BECK









36

BIOLOGICAL TREATMENTS FOR PSYCHOLOGICAL DISORDERS



Typical

Method Disorders Treated Possible Side Effects Mechanism of Action



Electroconv ulsiv e

InRev16b

Sev ere depression Temporary conf usion, Uncertain

therapy (ECT) memory loss



Psy chosurgery Schizophrenia, Listlessness, Uncertain

sev ere depression, ,

ov eremotionality

obsessiv e- epilepsy

compulsiv e

disorder



Psy choactiv e Anxiety disorders, Variable, depending on Alteration of

drugs depression, drug used: mov ement neurotransmitter

obsessiv e- disorders, phy sical sy stems in the brain

compulsiv e dependence

disorder, mania,

schizophrenia









37

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)







38

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







40

Average Average

untreated treated

person person

Number

of

people



80% of

untreated

persons



No improvement Outstanding

improvement







PSYCHOTHERAPY VS NONE 41