Disorders

Document Sample
Disorders Powered By Docstoc
					Disorders & Therapies

    What is abnormal?
         A little history – Q1
• How has the concept of mental illness
  changed over time?
• Middle ages – often religious or astrology
  (lunatics)
• What was Bethlem Hospital?
• Who was Dorothea Dix?
  Q2 - What is abnormal today?
• Atypical behavior - Q3
  – Cultural influence
  – Statistical tools
• Maladaptive behavior
• Disturbing to others
• Irrational
          Perspectives – Q4
• Applying perspectives to understanding
  mental illness and to treating it
• Cognitive, biological, behavioral,
  psychodynamic, biopsychosocial
• A note on psychoanalytic vs
  psychodynamic – what’s the difference?
• Strengths and limitations of using
  perspectives
             Labeling – Q5
• Rosenhan study 1973
• See youtube video

• Are there benefits to labeling?
   DSM IV TR- Diagnostic and
     Statistical Manual – Q6
• Diagnostic criteria for all American
  Psychiatric Association disorders
• Statistical info on distribution in population
• Little etiology
• No treatment info
• Too many disorders?
• Labeling?
• www.dsm5.org
                DSM – Q7
• Axes
  – Axis I: Mental disorders
  – Axis II: Personality disorders and mental
    retardation
  – Axis III: Physical conditions/Illness
  – Axis IV: Psychosocial/Environmental
  – Axis V: GAF
• Codes
                 Disorders
•   Mood disorders
•   Anxiety disorders
•   Personality disorders
•   “Organic” disorders – medical condition
•   Dissociative disorders
•   Somatoform disorders
•   Psychotic disorders
                  Mood
• Depression
• Mania
• Bipolar
• Disorders built on episodes - episodes are
  not disorders
• See handouts on Depressive episode, Major
  Depressive disorder, Bipolar II
  Types of mood disorder – Q8
• Unipolar
  – Major depressive disorder
  – Dysthymic disorder
• Bipolar
  – Bipolar disorder
  – Cyclothymic disorder
             Prevalence – Q9
• Bipolar I and II
  – .5% to 1.6% for men and women
• Major depressive disorder
  –   10 - 25% of women lifetime
  –   5 - 12% of men lifetime
  –   120 million worldwide
  –   5% of Americans at any time
  Etiology of mood disorders? –
               Q10
• Genetic - twin and family studies - concordance
  with MZ = 40 - 70%
• Neurotransmitters - serotonin and norepinephrine -
  evidence may be that receptors are limited or
  defective - don’t use properly
• Sleep abnormalities
• 3 stressful events in 60 days - 80% of episodes
  preceded by stress
• Social cognition - vicious cycle
    Medical therapies for mood
         disorders – Q11
• Depression
   – SSRIs increase serotonin availability
   – MAOIs - prevent breakdown of ser, nor, dop
   – Teenagers?


• Bipolar - lithium reduces the severity of highs and
  lows
   Interpersonal therapy – Q12
• Grounded in Freud - depression occurs
  within interpersonal context - therapy
  focuses on relationships - some can be
  fixed, some can’t
• Childhood experiences important but not
  focus of IPT
       Behavioral therapy – Q13
•   Classical Conditioning
•   Counter-conditioning
•   Exposure therapy
•   Systematic desensitization
•   Aversive conditioning
•   Operant conditioning
    Cognitive therapies – Q13
• Ellis and REBT
• Beck and cognitive
• Designed to change way one thinks about
  problems
    Rational Emotive Behavior
     Therapy – REBT – Q14
• Developed by Albert Ellis - assumes
  irrational beliefs cause bad emotions
• “I have to perform perfectly in today’s
  game.” When the client fails to perform
  perfectly, results are negative feelings,
  depression, etc
• Therapist challenges this thought and
  teaches client skills to think more rationally
           Cognitive therapy
• Developed by Aaron Beck
• Widely used to treat depression
• Cognitive schemas have become distorted
  perceptions of the world
• Challenge the perceptions - “nobody likes me”
• When depressed write down the situation, the
  emotion, the automatic thought, a rational
  response, the outcome
• Forces cognitive schemata to attention
 Cognitive behavioral therapy –
          CBT – Q15
• Combines cognitive and behavioral
  techniques
• Example: OC behaviors - relabel OC
  thoughts - “my brain is acting abnormally
  again”
• Engage in different, enjoyable behavior for
  15 minutes
• Relabeling yields a reward
Success treating mood disorders?
              – Q16
• Depression: CBT and interpersonal
  therapies show about 60% success; with
  medication: 75%

• Chronically/severely depressed adults: CBT
  or IP: 48%; with meds: 75%
          Anxiety disorders
• Panic attack - see handout
• Obsessive Compulsive Disorder
  – OCPD is different!
• Specific phobia
     Etiology for anxiety? – Q17
•   Situational - cues
•   Cognitive - learned fear from parents
•   Overreaction to fearful events
•   More women than men - 2:1
          Stress and Anxiety
• Short term stressors - treat the symptoms
  – Drugs, relaxation, breathing, yoga
Treating anxiety disorders - Q18
• Drugs may treat symptoms
  – Benzodiazepines - Valium, Xanax
                 CBT – Q19
• Cognitive and behavioral components
• Revise thinking processes
  –   What is real threat?
  –   What’s an appropriate response?
  –   Recognizing responses
  –   Practicing responses
               CBT – Q20
• CBT -
  – Systematic desensitization – Mary Cover Jones,
    Joseph Wolpe – exposure plus relaxation
  – Response prevention
  – Interoceptive training – simulates physical
    effects of a panic attack
   Dissociative disorders – Q21
• Disruption in the usually integrated
  functions of consciousness, memory,
  identity
• Transient or chronic
• Sudden or gradual
        Dissociative disorders
• Dissociative amnesia - inability to recall
  important personal information
• Dissociative fugue - travel to new location,
  inability to recall personal info / new
  identity
• Dissociative identity - multiple identities,
  identity fragmentation, not separate
  personalities
  Dissociative identity disorder
• Different personalities may emerge in
  different stressful situations
• Some reports of severe childhood physical
  and sexual abuse
• Main personality often depressed, passive
• Found in many cultures
• More common in women (3 or more to 1)
  Dissociative identity disorder
• Women tend to have more personalities - 15
  on average vs 8 for men
• Not caused by substance abuse
      Personality disorders – Q22
•   Paranoid
•   Antisocial
•   Histronic
•   Narcissistic
•   OCPD
•   Borderline
                   Etiology?
• Personality - enduring pattern of thinking, feeling,
  relating to others - when sufficiently maladaptive,
  it is a disorder
• Generally adolescence or early adulthood
• APD more frequent in men
• Histrionic, dependent more common in women
      Treatment for personality
             disorders
• ?
   Somatoform disorders – Q23
• Presence of physical symptoms that seem to
  suggest a medical problem
• Conversion disorders
• Pain disorder
• Hypochondriasis - preoccupation with fear of
  having a serious disease
• Body Dysmorphic disorder - excessive concern
  with real or imagined physical flaw, BIID
• Koro - SE Asia - concern that the penis, labia,
  nipples or breasts are shrinking and may disappear
  into the body, causing death
         Conversion disorder
• May affect 5 in a thousand people
• Not intentionally produced
• May have secondary gains
• Be careful about diagnosis - may be
  difficult medical case - early years - 1/4 to
  1/2 misdiagnosed
• Paralysis, anesthesia, seizures that do not
  record in EEGs
           Psychotic disorders
•   Delusions and hallucinations w/o insight
•   D&H with insight
•   Loss of ego boundaries
•   Impairment in reality testing
             A little history
• Freud distinguished between neurotic and
  psychotic disorders
• Generally, neurotic disorders are anxiety
  disorders with the patient still in contact
  with reality
• Generally, psychotic disorders involve loss
  of contact with reality
                Schizophrenia
• “split brain” no longer applies
• Bizarreness -
   – Yes - my internal organs were replaced by the FBI
   – No - the FBI may be watching me
• Thought disorder - focus on speech due to
  difficulty of defining “thought”
• Catatonia - complete unawareness of environment,
  rigid posture, purposeless motor activity
Types of schizophrenia – Q24, 25
• Disorganized
• Catatonic
• Paranoid
• Spectrum of disorders
• Generally adolescent or later
• 1% worldwide, present in some form in most
  cultures
• Women: later, milder, more likely to recover
       Schizophrenia symptoms
• Symptoms include
  –   Delusions and hallucinations
  –   Incoherent speech
  –   Disorganized or catatonic behavior
  –   Poor social and self-care functioning
  –   Attentional difficulties - stimuli flooding
  –   Flat or inappropriate affect
              Schizophrenia
•   Enlarged lateral ventricles
•   Decrease in gray and white matter
•   Shrinkage of temporal lobe
•   Decreased activity in frontal lobe
•   Onset - midteens to late 30s
•   Socially isolated / impaired?
•   Worldwide - 1% or so of population
 Etiology of schizophrenia – Q26
• Genetic
   – Very strong evidence here - eg 48% for mz twins;
     adoptee studies
• Biological
   – Excess or over-utilizing of dopamine
   – Fetal viruses?
   – Enlarged ventricles; prefrontal cortex
• Psychodynamic
   – Disturbed relationships with mother?
• Diathesis-stress model – predisposition plus stress
              Schizophrenia
• Genetic - higher rates for ID, fraternal twins
  and 1st degree relatives
• Women respond to treatment better
   Treatment of schizophrenia –
              Q27
• Neuroleptics - block action of dopamine but
  have risk of tardive dyskinesia, incurable
  involuntary movements
• Clozapine and other anti-psychotics
• Social rehabilitation
• Social support
• Learning theory to adjust behavior
• How effective? Varies dramatically
    Malingering and Factitious
         disorder – Q28
• Malingering is the intentional presentation
  of medical symptoms in order to escape
  duty or gain reward - convicts
• Factitious disorder is presenting medical
  symptoms in order to play the role of a sick
  person - other rewards are NOT important
Organic disorders – Q29
• http://psychcentral.com/news/2008/10/08/st
  -johns-wort-can-help-with-
  depression/3089.html

• St John’s Wort works for depression
  Classic Freudian therapy
            Q30



  Psychoanalysis, transference, free
association, dreams, defenses, insight
Forensic psychology/psychiatry –
              Q31
• Intersection of psychology and the legal
  system – can include assessments of
  individuals to determine ability to stand
  trial, commitment hearings, custody
  hearings, treatment of offenders, etc
• Note that profiling is a law enforcement
  specialty
                  Insanity
• A legal term, not a psychological one

• Inability to take responsibility for actions,
  not necessarily innocent

• John Hinckley and Ronald Reagan
        Group therapy – Q32
• Effective, cheaper than individual therapy
• Problems considered in a social context,
  particularly in family therapy
• Social and emotional support
• AA and similar 12-step programs
        Cultural issues? – Q33
• Religious beliefs
• Individualistic vs collectivist cultures
• Language barriers
         Does therapy work?
• Medical therapies
• Medical + psychotherapy can provide
  additional help in context of the problem,
  skills to manage problems
• All provide hope, perspective, relationship
  benefits; most patients and therapists see
  therapy as positive
• EMDR – worthwhile or not?
Preventing psychological illness?
• Resilience – the ability to respond
  effectively to life’s challenges
• Eliminating poverty, discrimination,
  malnutrition
• Training for competence – child-rearing,
  emotional intelligence, empathy, FAE
           Names to know
• Freud, Aaron Beck, Albert Ellis, Mary
  Cover Jones/Joseph Wolpe, Rogers, Skinner