Psychological Disorders

Transcription

1 Myers PSYCHOLOGY Chapter 16 Psychological C16:1 Psychological C16:2 Widespread and debilitating effects WHO (2001) Estimated 450 million people worldwide suffer psychological disorders Account for 15.4% of years of life lost due to death or disability, slightly below cardiovascular and above cancer USA 2.1 million per year admitted as inpatients Another 2.4 million outpatients 1 in 5 people need some help each year, twice that at some time in their lives Outline Perspectives on Psychological Defining Thinking Critically: ADHD Classifying Labeling Thinking Critically: Insanity and Responsibility Anxiety Generalized Anxiety and Panic Phobias Obsessive-Compulsive Post-Traumatic Stress Explaining Anxiety Thinking Critically: Dissociation and Multiple Personality Mood Major Depressive Bipolar Explaining Mood Close-up: Suicide Schizophrenia Symptoms Subtypes Personality Antisocial PD Antisocial PD Rates of Psychological C16:3 Perspectives: Defining C16:4 Psychological is a harmful dysfunction in which behavior is judged to be: Atypical: not enough in itself, and sometimes disorders widespread Disturbing: varies with time & culture Maladaptive: harmful Unjustifiable: occasionally justified Standards vary with History and Culture Sexual arousal and orgasm Homosexuality Hearing voices Thinking Critically: ADHD C16:5 Attention Deficit Hyperactivity (ADHD) More common today than in past CPA estimates about 4% of children Three key symptoms: Inattention, Hyperactivity, Impulsivity 2 to 3 times more common in boys Rates vary across nations, regions, teachers, Heritable, treatable by stimulants and psychotherapy Questions about over-diagnosis, long-term effects of medications, Perspective: Understanding (Etiology) Historical Causes and Treatments Supernatural events Movements of sun or moon, evil spirits, possession, Lunacy: full moon Treatments Exorcism, caged like animals, beaten, burned, castrated, mutilated, blood replaced with animal s blood C16:6 1

2 Medical Model C16:7 Diseases have physical causes and can be diagnosed, treated, and often cured Mental illnesses can be diagnosed on basis of symptoms and cured through therapy, which may include treatment in psychiatric hospital Much attention at present to identify biochemical and genetic factors that underlie mental disorders Bio-psychosocial Perspective Biological, sociocultural, and psychological factors combine and interact to produce psychological disorders (right) Taxonomy or Classification Grouping like elements (e.g., disorders) together Similar Symptoms, Etiology, Treatment, DSM-IV-TR American Psychiatric Association s Diagnostic and Statistical Manual of Mental (Fourth Edition, Text Revision) Widely used system for classifying psychological disorders Developed in coordination with ICD-10: WHO s International Classification of Diseases Perspectives: Classifying C16:8 Earlier important distinction Neurotic disorders (term seldom used now) Distressing but allow one to think rationally and function socially Freud: neurotic disorders are ways to deal with anxiety Psychotic disorder Lose contact with reality Experience irrational ideas and distorted perceptions (hallucinations) 5 Axes (+1) 15+ major categories in Axis I (+2) 400 disorders, increased from 60 disorders in 1950s Reliability of Diagnosis Historically a weak area for psychiatric diagnosis Now better criteria, structured interviews more common 83% agreement in one recent study C16:9 Classifying Psychological : Five Axes of the DSM IV Axis I Axis II Axis III Axis IV Axis V Is a Clinical Syndrome (cognitive, anxiety, mood disorders [16 syndromes]) present? Is a Personality or Mental Retardation present? Is a General Medical Condition (diabetes, hypertension or arthritis etc) also present? Are Psychosocial or Environmental Problems (school or housing issues) also present? What is the Global Assessment of the person s functioning? (100 point scale) C16:10 C16:11 C16:12 Perspectives: Labeling Some concern about negative consequences of labeling people with disorders Classic Rosenhan study Rosenhan and 7 other normal people admitted selves to psychiatric hospital complaining of hearing voices Acted normally once admitted Normal behaviors seen as symptoms (e.g., taking notes) Possible causes found in people s personal histories Average of 19 days before release Other studies show behavior interpreted differently depending on label (e.g., Langer interview study) Stigma associated with mental illness (+1) 3/4 refused to rent room to someone allegedly being released from mental hospital (same as for jail) Portrayed as dangerous and frightening in media 2

3 Insanity Defense Insanity and Controversial Sent to jail, not hospital Responsibility Dahmer: murdered 15 young men and ate parts Kacsynski: Unabomber killed 3 and injured 23 Kinkel: killed parents, 2 fellow students, wounded 25 Andrea Yates: drowned her 5 children Li: beheaded stranger on bus Mental and Justice system 16% US inmates have severe mental disorders (283,000) Some were executed Difficult balance Compassion for those with mental disorder, and Personal responsibility for our acts, including bad ones C16:13 C16:14 Perspectives on Psychological Defining Thinking Critically: ADHD Classifying Labeling Thinking Critically: Insanity and Responsibility Anxiety Generalized Anxiety and Panic Phobias Obsessive-Compulsive Post-Traumatic Stress Explaining Anxiety Thinking Critically: Dissociation and Multiple Personality Outline C16:15 Mood Major Depressive Bipolar Explaining Mood Close-up: Suicide Schizophrenia Symptoms Subtypes Personality Antisocial PD Antisocial PD Rates of Psychological Anxiety Anxiety C16:16 Distressing, persistent anxiety Or maladaptive behaviors that reduce anxiety Generalized Anxiety Person is tense, apprehensive, and in a state of autonomic nervous system arousal Unable to identify cause, free floating Panic Minutes-long episode of intense dread in which person experiences terror and accompanying chest pain, choking, or other frightening sensation Perceived as heart-attack, come to fear fear itself Phobia Persistent, irrational fear of a specific object or situation Some common and uncommon fears (below +1) C16:17 C16:18 3

4 Obsessive-Compulsive Unwanted repetitive thoughts (obsessions) and/or actions (compulsions) C16:19 An Example of OCD: Howard Hughes (The Aviator) C16:20 Leonardo DiCaprio s characterization of OCD in movie is reportedly quite good Repetitive phrases: striving to get things right Awareness at some level that behavior is not appropriate: covering mouth to avoid repetition Compulsive hand-washing: cleaning rituals to alleviate fear of germs, infection, and disease Hughes wealth allowed him to develop elaborate rituals carried out by his staff Four or more weeks of following symptoms Haunting memories Nightmares Social withdrawal Jumpy anxiety Sleep problems Associated with More intense trauma Closer proximity (e.g., 9/11) Concerns about PTSD Overdiagnosed? Trauma counseling ineffective or harmful in some cases Resilience of survivors Post- Traumatic Stress C16:21 Explaining Anxiety C16:22 Learning Perspective Fear Conditioning: 58% of people with social phobia experienced disorder after traumatic event Horley et al (2004): Social Phobics avoid looking at eyes of angry faces (above, early experiences?) Stimulus Generalization Avoidance or Escape behaviors: Negative Reinforcement Observational Learning Biological Perspective Natural Selection: predispositions to fear certain kinds of objects and events (snakes, confinement) and engage in certain ritual behaviors (hand-washing) Genes: higher prevalence of anxiety in identical twins Reduced GABA levels: GABA is inhibitory neurotransmitter Physiology: over-arousal of frontal lobe areas involved in directing attention and impulse control, as in PET Scan of brain of person with Obsessive/ Compulsive disorder (top); high metabolic activity (red) in frontal lobe areas; or overactivity of brain region involved in error checking (bottom) C16:23 Cognitive Perspective Attentional and other cognitive processes play role in anxiety (and other psychological disorders) Emotional Stroop task: name ink color of words that are either Threatening or Non-Threatening Study with Adolescents who also completed Beck Anxiety Inventory (BAI). Measured time (sec) to read Stroop card. Words Low BAI High BAI Non-threatening Threatening Difference * Interference index calculated by subtracting time to read colors of threat words from time to read colors of neutral words: r with BAI = +.42 C16:24 4

5 C16:25 Thinking Critically: Dissociation and Multiple Personalities Dissociative experiences (mild forms common) Lack of awareness of activities, feeling different or unreal, viewing self from external perspective, Dissociative Identity 2+ distinct identities without awareness of one another Controversial Strong evidence according to 11% psychiatrists: e.g., some evidence for distinct brain states Skeptics Explosion in diagnosis Marked increase in # personalities (mean 3 prior to Sybil, 16 after) Incidence varies across therapists and nations Use of hypnosis (Iatrogenic) Fantasy-prone personalities Outline Perspectives on Psychological Defining Thinking Critically: ADHD Classifying Labeling Thinking Critically: Insanity and Responsibility Anxiety Generalized Anxiety and Panic Phobias Obsessive-Compulsive Post-Traumatic Stress Explaining Anxiety Thinking Critically: Dissociation and Multiple Personality C16:26 Mood Major Depressive Bipolar Explaining Mood Close-up: Suicide Schizophrenia Symptoms Subtypes Personality Antisocial PD Antisocial PD Rates of Psychological Mood Mood Characterized by emotional extremes Two variants: Major Depressive and Bipolar Major Depressive Mood disorder in which person, for no apparent reason, experiences two or more weeks of depressed moods, feelings of worthlessness, and diminished interest or pleasure in most activities Symptoms (+1) C16:27 C16:28 Depression: Five (or more) of following symptoms present during same 2-week period Depressed mood most of day, nearly every day Markedly diminished interest in most activities most of day Significant weight loss when not dieting or weight gain Insomnia or Hypersomnia nearly every day Psychomotor agitation or retardation nearly every day Fatigue or loss of energy nearly every day Feel worthless or excessive guilt nearly every day Diminished ability to think or concentrate, or indecisiveness, nearly every day Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without specific plan, or suicide attempt or specific plan for committing suicide C16:29 Bipolar Mood disorder in which person alternates between hopelessness and lethargy of depression and overexcited state of mania Formerly called manic-depressive disorder Manic Episode Mood disorder marked by hyperactive, wildly optimistic state Symptoms (+1) May be associated with creativity Poets, Artists, Actors, C16:30 Manic Episode: Three (or more) of following symptoms present during same 1-week period Inflated self-esteem or grandiosity Decreased need for sleep (feels rested after three hours sleep) More talkative than usual or pressure to keep talking Flight of ideas or subjective experience that thoughts are racing Distractibility Increase in goal-directed activity or psychomotor agitation Excessive involvement in pleasurable activities that have high potential for painful consequences (sexual indiscretions, foolish business investments) 5

6 Characterization of Major Depressive (left) and Bipolar (right) C16:31 Explaining Mood C16:32 Facts to be explained by theory Many associated behaviors and cognitions: lack motivation, recall negative events, negative expectations, Stressful events often precede depression: Incidence of 1% if 0 stressful events, 24% for 3 or more Major Depressive Episodes often Self-Terminate Increase in rates of depression (and other disorders), and also earlier onset (+1) Widespread (+2) More common in women (+2 +3), but suicides (later) Affects all ages, but especially young (+3) Also suicide facts (later slides) C16:33 C16:34 C16:35 Suicide Facts Higher rates for Rich, Nonreligious, Non-married Cultural (National & Ethnic) differences (right) Relative to Canada, Australia, and USA (CAU) England, Italy, Spain: 1/2 Austria, Finnish: 2x Lithuanians: 15x Portuguese White Americans 2x Black (+1) Aboriginals in Canada (+1) Gender Women more likely to try Men 2x to 4x more likely to succeed (not China) because of lethal means (6/10 bullet to head in USA) (+2) Age differences (+1 +2) Trends across time (+2 +3) C16:36 6

7 C16:37 C16:38 Increasing rates of teen suicide Suicide rate, ages 15 to 19 (per 100,000) C16:39 C16:40 Assessing risk of suicide attempt and success Emotions and Thoughts: Feelings of depression. Think and talk of suicide. Seriousness of intent: Plan for suicide, Lethality of plan, Means to carry out plan Plans for future History: Previous attempts Depression + Anger motivated by cry for help Depression + Hopelessness motivated by death Year Explanation: Biological Perspectives C16:41 Genetic Influences Higher incidence with higher degrees of genetic relatedness. Concordance of 57% in identical twins and 14% in fraternal twins Linkage studies to identify relevant genes Depressed Brain Neurotransmitters Norepinephrine, Serotonin low during Depressed state (+1) Norepinephrine high during Manic state Brain activity (+2) Pet Scan for serotonin Person in depressive episode Healthy Person C16:42 7

8 PET scans show that brain energy consumption rises and falls with emotional swings C16:43 Biological Rhythm Dysfunction Sleep disturbances Seasonal Affective : latitude? (below) Have you cried today? % Yes Men Women August 4% 7% December 8% 21% C16:44 C16:45 Explanation: Social-Cognitive Perspective Historical psychological models Psychodynamic Perspective: Intrapsychic conflict Current psychological model(s) more integrated Models emphasize role of Cognition and Emotion (i.e., psychological states and processes), as well as biology Reciprocal relations among various elements (+1) Stressful Life Events Discussed in earlier chapter Specifically, Social-Cognitive model hypothesizes cyclic relations among various psychological processes (+2) 1. Stressful experiences 2. Negative explanatory style (+3) 3. Depressed mood 4. Cognitive and Behavioral changes C16:46 C16:47 The vicious cycle of depression can be broken at any point Negative Explanatory Style Learned Helplessness / Hopelessness (Seligman) (+1) Attributional Style Can lead to feelings of Hopelessness (+1) Explain bad events in terms that are Stable, Global, and Internal (+2) Beck Pessimistic view of self, world, and future; Irrational beliefs (+3); and Errors in Thinking C16:48 8

9 Helplessness/Hopelessness Theory Learned Helplessness Bad things happen Hopelessness Bad things happen Sense of Helplessness Attribution style Depression Sense of Hopelessness C16:49 Depression Attributional style of depressives Why I failed my test. Internal I have taken too many classes Stable I am a lousy student (not I did not study this time) Global I am a failure (not I did not do well in one test) Such attributions lead to feelings of hopelessness because causes can seem so pervasive and unchangeable C16:50 Irrational Beliefs (Beck) C16:51 1. Must have love and approval nearly all time from people important to you. 2. Must be completely competent in all endeavors, or must have real expertise or talent in something important. 3. Life must go way you want. Things are awful when you don't get first choices. 4. Other people should treat everyone fairly. People who are unfair or unethical are horrible and rotten, and are to be punished or avoided. 5. People and things should turn out better than they do turn out. It's awful and terrible when quick solutions to life's hassles are not forthcoming. 6. Your past is strong influence on your behavior and must continue to affect you and determine your behavior. 7. You can find happiness by inertia, inactivity, or passivity. Negative Mood Feeds Negative Thoughts Judge same behavior of self more negatively when sad (blue) than happy (red) (right) Vicious Cycle People who ruminate and catastrophize with self-blaming thoughts more at risk for depression Women more likely to ruminate on negative events 35% Negative behaviors Self-ratings C16:52 Positive behaviors More common in people who are alone Unmarried, unattached, young Work-related moves C16:53 Loneliness Four types: Feel excluded, Feel unloved, Feel constricted (unable to share), Feel alienated (different) Self-blame Tend to be shy, lack self-esteem, less socially competent (how to introduce self, participate in groups), negative interpretations of social acts, remember negative events Outline Perspectives on Psychological Defining Thinking Critically: ADHD Classifying Labeling Thinking Critically: Insanity and Responsibility Anxiety Generalized Anxiety and Panic Phobias Obsessive-Compulsive Post-Traumatic Stress Explaining Anxiety Thinking Critically: Dissociation and Multiple Personality C16:54 Mood Major Depressive Bipolar Explaining Mood Close-up: Suicide Schizophrenia Symptoms Subtypes Personality Antisocial PD Antisocial PD Rates of Psychological 9

10 Schizophrenia Schizophrenia Literal translation split mind Psychotic Group of severe disorders characterized by: Disorganized and Delusional thinking Disturbed Perceptions Inappropriate emotions and actions Symptoms very disruptive Live in private inner world Socially withdrawn and isolated much of lives C16:55 C16:56 Disorganized Thinking Delusions: False beliefs, often of persecution or grandeur, that may accompany psychotic disorders Word salad speech: I am fine apple pie no sale furniture store take it slow cellar door Break-down in selective attention, capacity to inhibit irrelevant material Disturbed Perceptions Hallucinations: False sensory experiences, such as seeing or hearing something without any external physical stimulus Usually auditory Negative messages: bad, hurt self, Inappropriate Emotions and Actions Inappropriate responses: e.g., laugh at sad event Flat Affect: appears like apathy Senseless, compulsive acts: e.g., rocking Catatonia: motionless for hours, then agitated Schizophrenia C16:57 Schizophrenia C16:58 C16:59 Brain abnormalities Understanding Higher risk if maternal virus Schizophrenia during midpregnancy Flu epidemic during midpregnancy Densely populated areas at greater risk of viral disease Born during winter and Spring months in Northern Hemisphere and reverse in Southern Hemisphere Mother reported being sick with flu, especially 2nd trimester Higher levels of flu-related antibodies in mothers Neurotransmitters Dopamine overactivity and positive symptoms: hallucinations, paranoia Glutamate underactivity and negative symptoms: withdrawal Brain Anatomy Low activity in frontal lobes Enlarged fluid-filled areas (+1) and shrinkage of cortex (+2) Low birth-weight, oxygen deprivation, prenatal under-nutrition Schizophrenia C16:60 10

11 C16:61 C16:62 Understanding Schizophrenia Genetic factors Inherit predisposition 1/100 baseline incidence 1/10 in those with affected sibling or parent 1/2 with affected identical twin, whether reared together or apart (+1 +2) 6/10 if shared single placenta 1/10 if twins had separate placentas Adopted higher if Biological parent affected, not Adoptive parent Varying degrees of genetic relatedness (+3) Older father increases incidence: More mutated DNA in sperm cells Multiple genes involved (polygenic) C16:63 C16:64 Genain quadruplets All identical twins All affected with Schizophrenia, two more seriously C16:65 C16:66 Understanding Schizophrenia Psychological Factors Disturbed communication with parents Causal direction? Follow high risk children for years. More at risk if: Birth complications: oxygen deprivation, low birthweight Mother s schizophrenia severe and long-lasting Separation from parents Short attention span and poor muscle coordination Disruptive or withdrawn behavior Emotional unpredictability Poor peer relations and solo play Difficult to separate Environmental from Genetic effects and from (Early) Symptoms 11

12 Outline Perspectives on Psychological Defining Thinking Critically: ADHD Classifying Labeling Thinking Critically: Insanity and Responsibility Anxiety Generalized Anxiety and Panic Phobias Obsessive-Compulsive Post-Traumatic Stress Explaining Anxiety Thinking Critically: Dissociation and Multiple Personality C16:67 Mood Major Depressive Bipolar Explaining Mood Close-up: Suicide Schizophrenia Symptoms Subtypes Personality Antisocial PD Antisocial PD Rates of Psychological Personality C16:68 Inflexible and enduring behavior patterns that impair social functioning, usually without anxiety, depression, or delusions Three clusters Sensitivity to Rejection: e.g., Avoidant PD Eccentric: e.g., Schizoid PD Dramatic or Impulsive Histrionic PD: shallow, attention-getting emotions Narcissistic PD: exaggerate own importance Borderline PD: unstable identity and relations Antisocial PD: most troubling (next few slides) Antisocial Personality Person (usually man) exhibits lack of conscience for wrongdoing, even toward friends and family (e.g., Bernardo, right) Aggressive and ruthless or clever con artist Previously called Sociopath or Psychopath More common in, but not majority of criminals, nor limited to criminals Little regret Henry Lee Lucas: many murders; Once I ve done a crime, I just forget it. Partner Toole I think of killing like smoking a cigarette, like another habit. Hare Psychopathy Check List (+1) C16:69 C16:70 Antisocial Personality C16:71 Biological Low arousal (+1) Weak frontal lobe functioning (+2) Genetic influence shown in Twin and Adoption studies Early temperament: impulsive, uninhibited, unconcerned with social rewards, low in anxiety Environment also important Increased violence cannot be explained by change in genes Environmental/Biological risk factors (+3) Interaction between Genes and Environment Gene Maltreatment No No No Yes Yes No Yes Yes +++ C16:72 13 year-old boys later convicted of crime showed relatively low arousal 12

13 C16:73 PET scans illustrate reduced activation in a murderer s frontal cortex Normal Murderer Antisocial Personality C16:74 Outline Perspectives on Psychological Defining Thinking Critically: ADHD Classifying Labeling Thinking Critically: Insanity and Responsibility Anxiety Generalized Anxiety and Panic Phobias Obsessive-Compulsive Post-Traumatic Stress Explaining Anxiety Thinking Critically: Dissociation and Multiple Personality C16:75 Mood Major Depressive Bipolar Explaining Mood Close-up: Suicide Schizophrenia Symptoms Subtypes Personality Antisocial PD Antisocial PD Rates of Psychological C16:76 Psychological Widespread NIMH study of 20,000 people in 1980s 1/6 Americans clinically significant mental disorders Britain s Office of National Statistics (2002) 1/6 rate of active disorders Australian survey of 10,600 adults In any year slightly less than 1/6 have mental disorder Australian survey 4,500 children and adolescents 1/7 had mental health problems Canadian Statistics (+1) C16:77 1 in 5 Canadians will experience, during their lifetime, mental illness serious enough to impair functioning 3% of those (nearly 1 million Canadians) suffer from severe and persistent mental illness 1% of Canadians suffer from schizophrenia 4,000 people a year die prematurely by suicide Disability due to depression seriously affects 10 out of 100 people at some point in their lives along with their families and places of work, and is leading cause of disease burden among women years of age in developed world Only 1 out of 5 children who need mental health services receives them C16:78 13

14 Moderating Factors Age: 75% experience first symptoms by age 24 Doubly high among those below poverty line Varies with Nationality (right WHO 2004, prevalence during preceding year ) Gender and Ethnicity (+1) Variety of Risk and Protective Factors (+2 +3, WHO, 2004) C16:79 C16:80 C16:81 C16:82 Conclusions C16:83 Definition and measurement of psychological disorders a challenge Identifying defining and characteristic features Overlapping symptoms across disorders Possible negative consequences of labeling Complex causal factors at multiple levels Diathesis Stress models increasingly common: i.e., interaction between predisposition to disorder and some stressor Neurotransmitters and Brain Regions Bio-Psycho-Social Models Treatment similarly complex Chapter 17 14