Emotional Health
Emotional/Mental Disorders
Emotional Health
Crisis Clinic, King County
– 24-hour phone line: 206-461-3222
– Toll free: 866 4CRISIS (866-427-4747)
– TDD line: 206-461-3219
Outside of King County, call 911 or 1-800-
SUICIDE
Health & Human Services Info
– 206-461-3200/800-621-4636
– TDD: 206-461-3610
What is Emotional /Mental
Health?
Accurate perception of reality
Adaptation to change
Ability to cope
Ability to think in organized manner
Ability to assess one’s own behavior
Emotional/Mental Disorders
General
classifications
Diagnostic
classifications
General Classifications
Neurosis
Psychosis
Neurosis
Emotional disorder caused by unresolved
conflicts, leads to anxiety
A neurotic individual can grasp reality
A neurotic person has irrational thoughts
Behavior may not make sense
A neurotic person is aware of irrational
thoughts, behaviors, but has problems fixing
them
Neurosis
Pop culture example
Psychosis
Sense of reality is distorted
– Hallucinations: hearing/seeing something
that does not exist
– Delusions: Irrational beliefs not based on
reality
Extremely disorganized thinking
Personality changes
Psychosis
Example: Tom Harrell
Diagnostic Classifications
Diagnostic and Statistical Manual of Mental
Disorders (DSM-IV) published in 1994
Revised since that time (DSM-IV-TR)
– Changes: Alzheimer’s, Tourette’s, personality
change, exhibitionism, voyeurism
– DSM-V publication date 2013
Many categories of disorders, including:
– Anxiety disorders
– Mood disorders
– Schizophrenia
Anxiety Disorders
Anxiety Disorders
Characterized by feelings:
– Apprehension
– Fear
– Alarm
– Terror
Anxiety occurs in situation where
average individual is unaffected
Anxiety Disorders - Resources
A few provided for OCD, PTSD
General: Anxiety Disorders Association of
America
– Therapist lookup
– Free webinars with registration
Anxiety Thursdays (fee = $50 for group;
OCD, panic disorder, social anxiety,
trichotillomania)
– Info: 206-285-0900; dkosins@u.washington.edu
– Place: 318 W. Galer St., Suite #201
Generalized Anxiety Disorder
Vague feeling of worry or dread
– Job, family, home, health, etc.
A feeling that something is wrong
Worry is out of control
Characterized by: fatigue, restlessness,
irritability, difficulty concentrating, muscle
tension, sleep disturbances
Occurs for at least six months
Experienced distress is significant
Video Clip
Phobia
Fear is focused irrationally on particular
object/situation
Anxiety is severe
– Phobic person recognizes irrationality
Examples?
Distress interferes with life
Duration at least six months (adults)
Example of emetophobia
Panic Disorder
Recurrent, unexpected panic attack
Panic attack: four or more of the following
– Increased heart rate
– Increased breathing frequency
– Sweating
– Trembling
– Chest pain/discomfort
– Nausea
– Dizziness
– Fear of dying/losing control, feelings of detachment
– Attacks not due to chemical substance
Panic Disorder With
Agoraphobia
Agoraphobia
– Anxiety over situations/places where
escape is difficult (or embarrassing)
– Usually situations outside the home
– The situations are avoided or endured with
extreme discomfort
Panic Disorder Without
Agoraphobia
Panic attacks
– Same criteria as “panic disorder with
agoraphobia”
Agoraphobia is absent
Obsessive-Compulsive Disorder
Obsession
– Recurrent, persistent thought, impulse or
image experienced as inappropriate,
marked by anxiety
– Thought, impulse, image not about real-life
problems
– Person attempts to ignore/suppress
– Individual recognizes irrationality
– Examples
Common Obsessions
Need for order,
organization,
exactness
Concern over germs
Fear of evil thoughts
Fear of doing harm
to self or others
Obsessive-Compulsive Disorder
Compulsion
– Repetitive behaviors/acts relating to
obsession
– Behaviors/acts aimed at reducing anxiety
– Examples
Common Compulsions
Counting to a
specific number
Arranging objects in
specific ways
Cleaning, bathing
Seeking of
reassurance
Video Clips
Pop culture
Real life
Obsessive-Compulsive Disorder
Obsession/Compulsion
Person recognizes obsessions/compulsions
are unreasonable
Obsessions/compulsions cause significant
distress
Not due to chemical substance
Yale-Brown Obsessive-Compulsive Scale
OCD Treatment, Resources
Treatment: medication, cognitive-behavior
therapy
PET Scans to Insure Correct Treatment
(WebMD)
Gamma knife surgery
“Giving Obsessive-Compulsives Another
Lifestyle” (GOAL) meetings at Swedish
Hospital (747 Broadway), 1st and 3rd
Saturdays, 10am-12pm
Post-Traumatic Stress Disorder
Person exposed to an event threatening
injury or death to self/others (examples)
Event re-experienced
– Images/thoughts/perceptions
– Dreams
– Intense reactivity to cues or symbols of event
– Example (0:40-5:09; disturbing clip)
Post-Traumatic Stress Disorder
Avoidance of triggers, reduced
responsiveness
– Thoughts, feelings, conversations
– Activities, places, people associated with trauma
– Inability to recall an aspect of the trauma
– Reduced participation in activities
– Feeling of detachment
– Sense of shortened future
Post-Traumatic Stress Disorder
Persistent symptoms
– Sleep difficulties
– Irritability
– Concentration difficulties
– Exaggerated startle response
Significant distress
Occurs for longer than a month
PTSD Resources
WA State Department of Veterans Affairs
PTSD Program: 800-562-2308
– VA Puget Sound Healthcare: 206-762-1010
(Seattle), 253-582-8440 (Tacoma)
PTSD Newsletter (via Yahoo groups)
Search for therapists via Psychology Today
Anxiety & Stress Reduction Center of Seattle
Name That Anxiety Disorder
Jimmy experiences episodes of
lightheadedness, rapid breathing, and
dizziness whenever he travels in a train.
Name That Anxiety Disorder
Mike is insistent on straightening
everything in his apartment. For
example, towels must be folded in a
specific manner and placed on a towel
bar so that ends of towels are even with
each other. Furniture is symmetrically
organized around the room to ensure
balance.
Schizophrenia
Schizophrenia
A “psychotic disorder”
Five forms of schizophrenia
Severe disturbances in perception,
thought, mood, behavior, or a
combination
Affects ~1% of population
Schizophrenia
Characterized by:
Positive Symptoms (should not be
present)
– Delusions
– Hallucinations
– Disorganized speech
Example: clang association/clanging
– Disorganized or catatonic behavior
Schizophrenia
Also characterized by:
Negative symptoms (something is
missing)
– Flat affect
– Poor rapport
– Difficulty with abstract thinking
– Lack of self-care
Schizophrenia
Work, social relations, self-care are
significantly affected
Minor physical anomalies: crossed eyes, ear
malformations, visible blood vessels in
nailbeds (children)
Signs occur for at least six months
Disturbance not due to chemical substance
Proposed change in DSM-V: “Schizophrenia
Spectrum” & Other Psychotic Disorders
Schizophrenia
Maurizio Baldini
Gerald (YouTube; first 3 minutes of 8)
Catatonic Schizophrenia
Abnormalities in speech, senses, movements
– Video clip (YouTube)
Excessive, sometimes violent motor activity;
or mute, unmoving, stuporous
– Echolalia
Example in autism (YouTube)
– Echopraxia
Disorganized Schizophrenia
Incoherent speech
Disorganized behavior
Flat or inappropriate emotional
response
Catatonic schizophrenia ruled out
Peter (YouTube; up to 2:38 of 9:00)
Paranoid Schizophrenia
Most commonly referenced form in
media
One or more auditory hallucinations
One or more delusions
– Persecution, grandeur
No disorganized speech, catatonic
behavior
Paranoid Schizophrenia
9-year old Rebecca (ABC News)
Linda Carmella Sibio
Louis Wain’s disease progression
ABC 20/20 Program from 2000
Undifferentiated Schizophrenia
With this diagnosis, the individual may
suffer from hallucinations, delusions,
disorganized speech or behavior, or
negative symptoms
Criteria for catatonic, disorganized,
paranoid schizophrenia not met
Residual Schizophrenia
History of prior schizophrenia
Negative symptoms persist (emotion/speech)
Delusions, hallucinations, disorganized
speech and behavior do not dominate
– Delusions, hallucinations may be on a smaller
scale (odd, unusual)
Early signs of relapse (“Box 3,” page 7, Birchwood et. Al,
Schizophrenia: Early Warning Signs. Advances in Psychiatric Treatment 2000, volume 6:
93-101)
Possible Causes
Genetics
Environment
Brain abnormalities
Neurotransmitter hypothesis
Schizophrenia and Genetics
There is no one gene associated with
schizophrenia
– Genes to Cognition chromosome map
Heredity and schizophrenia (schizophrenia.com)
Genetic predisposition may not be
enough
Schizophrenia and
Environment
Prenatal care, including nutrition (Vitamin D),
influenza vaccination
Complications at birth (newborn breathing issues,
maternal hypertension, others)
Exposure to virus during pregnancy
Relationship between schizophrenia and poverty
– Do complications inherent in poverty increase
likelihood for getting schizophrenia, or
– Does poverty result because an individual
diagnosed with schizophrenia is impaired?
Born in colder months (late winter/early spring)
Schizophrenia and Brain
Abnormalities
Difficult to ascertain
– Not necessarily obvious damage but
abnormalities on a cellular level
Prefrontal cortex, hippocampus
Enlarged brain ventricles (accessscience.com)
Schizophrenia &
Neurotransmitters
Dopamine
– Schizophrenics tend to have increased
sensitivity/too much released
– Hypothesized due to amphetamine effects
Glutamate
– Schizophrenia may inhibit glutamate
– Hypothesized due to PCP effects
Serotonin
– Elevated levels may be associated with schizophrenia
– Hypothesized due to hallucinogen effects
Schizophrenia Treatment
Medications
– Side effects
Uncontrollable movements (shaking, fidgeting,
involuntary facial contortions)
Weight gain
High blood sugar, cholesterol
Loss of sex drive
Psychosocial therapy
Hospitalization
– WA: Involuntary Treatment Act (72 hrs); petitions
required for longer periods
Schizophrenia Treatment
Although many diagnosed with schizophrenia
are disabled, others are able to work and
function
Tony Allard: His brother conducts an
interview (YouTube; at least through 5:00)
– Dennis Allard’s blog
Living with Schizophrenia: A Call for Hope
and Recovery
Schizophrenia Resources
Crisis Clinic: 206-
461-3222 (1-866-
4CRISIS toll free)
Community House
Mental Health (206-
362-0560)
Snohomish County:
(425) 388-7215
Mood Disorders
Mood Disorders
An exaggeration of mood (affect)
– Depression
– Mania
– Anger
– Irritability
Examples
– Major depressive episode
– Manic episode
– Bipolar I, Bipolar II
Mood Disorders - Change in
DSM-V
Proposed separate categories
– Depressive Disorders
– Bipolar and Related Disorders
Major Depressive Episode
Extreme sadness
Loss of interest in daily activities
Weight loss or gain
Sleep disturbances
Fatigue/loss of energy nearly every day
Diminished ability to concentrate
Recurrent thoughts of death
Not due to a chemical substance
Extreme impairment in daily functioning
Depressive Disorders
Dysthmic Disorder
Major Depressive Disorder
– Single Episode
– Recurrent
Two or more major depressive episodes
At least two months criteria for major
depressive episode are unmet
Manic Episode
Distinct period of elevated mood, at least one
week
Symptoms
– Inflated self-esteem
– Reduced sleep
– Talkativeness
– Racing thoughts, distractibility
Causes severe impairment
Not due to chemical substance
Bipolar Disorders
“Manic depressive”
Dramatic mood swings involving
depression, mania and/or hypomania
– Hypomania generally less severe than
mania
Video Clips (BBC)
Bipolar I Disorder
At least one manic or mixed episode
– Mixed: major depressive and manic
episodes are evident
There may also be major depressive
episodes and/or hypomania
Bipolar II Disorder
History of one or more major depressive
episodes
History of one or more hypomanic
episodes
No manic or mixed episodes
Symptoms cause significant stress
Other Bipolar Diagnoses
Cyclothymic
Disorder/
Cyclothymia
Rapid Cycling
Bipolar Disorder
Bipolar Disorder Not
Otherwise Specified
Other Bipolar Diagnoses