PSY 105 WEEK 8 Part 2 Mental Disorders: Their Nature, Causes, & Treatment Slide 1 Intro Welcome to Part

Two of Week Eight of Psychology from Science to Practice. This half of the lesson will cover the nature, causes, and treatment of mental disorders. Slide 2 Overview Please go to slide # 2 This lesson looks at the nature and causes of mental disorders using the most widely used tool for describing and classifying mental disorders the Diagnostic and Statistical Manual of Mental Disorders-four. We will also explore ways in which they can be treated to lessen the pain and discomfort they produce. Please go to slide # 3 When you complete this lesson you will be able to: Define assessment and explain the use of the DSM-IV; List and explain: o Disorders of infancy, childhood, and adolescence; o Mood disorders; o Anxiety disorders; o Dissociative disorders; o Somatoform disorders; o Sexual and gender identity disorders; o Personality disorders; o Schizophrenia; and o Substance-related disorders; List and explain several types of psychotherapies; Define group therapy; and List and explain several types of biological therapy. Please go to slide # 4

Slide 3

Objectives

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Slide 4

Assessment & Diagnosis: The DSM-IV & Other Tools

A psychologist goes through a set of informationgathering steps when seeing a patient for the first time a process known as assessment. The goal of an assessment is to formulate an accurate diagnosis by comparing the gathered information to standard definitions of various mental disorders crucial in determining the next step. The most widely used system for describing and classifying mental disorders is the Diagnostic and Statistical Manual of Mental Disorders-four, or DSMIV, classified along five axes or dimensions. The different axes relate to mental disorders, physical health, and social and occupational functioning. We will cover the major disorders located on the first and second axes in this part of the lesson. The first axis relates to major disorders themselves, whereas the second relates to mental retardation and personality disorders. The third axis involves general medical conditions relevant to each disorder; the fourth axis considers psychosocial and environmental factors; and the fifth axis relates to a global assessment of current functioning. Each disorder includes a description that focuses on observable features and diagnostic features symptoms that must be present before an individual is diagnosed as having a particular problem. Another important feature of the DSM-IV is that it reflects efforts to consider the potential role of cultural factors in mental disorders. Although the DSM-IV is a useful tool for psychologists and appears to be higher in reliability that earlier versions, it also has major shortcomings. First, it is largely descriptive in nature, lacking explanations. Second, it attaches specific labels to people, which may stimulate stereotypes about them. Third, it may be gender-biased. Fourth, it ignores the fact that mental disorders occur on a continuum rather than in discrete categories. Despite these shortcomings, psychologists continue to use the DSM-IV due to the benefits of using a single widely-used framework to describe and discuss mental disorders. Please go to slide # 5

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Slide 5

Disorders of Infancy, Childhood, & Adolescence

A number of disorders that adults experience first emerge during childhood or adolescence. Lets look at some of these disorders. The most common single reason children are referred to psychologists is disruptive behavior. Disruptive behavior is divided into two major categories oppositional defiant disorder and conduct disorder. Oppositional defiant disorder involves a pattern of behavior in which children have poor control of their emotions or repeated conflicts with parents and other adults. Oppositional defiant disorder may lead to serious difficulties later in life, including conduct disorder. Conduct disorder involves more serious antisocial behaviors that are potentially harmful to the child, others, or property. Another childhood mental disorder is attentiondeficit/hyperactivity disorder, or ADHD. There are three patterns of ADHD one in which a child cant pay attention; one in which they show hyperactivity or impulsivity; and one that combines the two. The causes of ADHD appear to be both biological and psychological. Fortunately, ADHD can be successfully treated with several stimulant drugs. Ritalin amplifies the impact of two neurotransmitters norepinephrine and dopamine in the brain, increasing the ability to pay attention and control behavior. However, Ritalin produces potentially harmful side effects. A new drug called Straterra appears to produce the beneficial effects of Ritalin, with fewer side effects. Many psychologists recommend treating ADHD with a combination of minimal doses of drugs and behavioral management programs. Additional disorders that often begin in childhood include feeding and eating disorders disturbances in eating behavior that involve maladaptive and unhealthy efforts to control body weight. Two of the most common eating disorders are anorexia nervosa and bulimia nervosa. Anorexia nervosa involves an intense and excessive fear of weight gain, with a distorted body image and refusal to maintain a normal body weight. More common among females than males, many young women show a pattern known as thin-ideal

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internalization they cognitively accept socially defined ideals of attractiveness and engage in behaviors to attain the ideal. Bulimia nervosa is a disorder in which individuals engage in recurrent episodes of binge eating followed by compensatory behavior designed to prevent weight gain. Evidence indicates that several factors contribute to both anorexia and bulimia including being overweight, being dissatisfied with ones body image, a tendency to seek perfection, and substance abuse. Childhood disorders that involve lifelong impairment in mental or physical functioning are described as pervasive development disorders. Autism, which appears to have important biological and genetic causes, is a type of pervasive development disorder that has received the most attention. Autistic children show three major characteristics: Marked impairments in establishing social interactions with others; Nonexistent or poor language skills; and Stereotyped, repetitive patterns of behavior or interests. Basically, children with autism seem to live in a world of their own; they make little contact with others, show little interest in others, and often treat others as objects rather than people. Slide 6 Mood Disorders: The Downs & Ups of Life Please go to slide # 6 Everyone has moderate swings in mood or emotional state. However, some suffer from mood disorders, experiencing wide and prolonged swings in their emotional state. Depression is one type of mood disorder, characterized by several criteria. First, persons suffering from depression experience profound unhappiness the majority of each day. Second, they report having lost interest in all usual pleasures of life. Third, they often experience significant weight loss or gain. Depression may also involve fatigue, insomnia, feelings of worthlessness, an inability to concentrate, and recurrent thoughts of death or suicide. When individuals experience five or more of these symptoms at once during the same two-week period, they are classified as showing a major depressive episode.

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Another type of mood disorder is bipolar disorder, in which people experience wide swings in mood. They move between deep depression and mania, in which they are extremely excited and energetic. Depression has both biological and psychological causes. Biological causes include genetics and brain biochemistry. The current view regarding abnormal brain biochemistry is that low levels of serotonin may allow other neurotransmitters to swing out of control, which leads to extreme changes in mood. Learned helplessness and negative self-schemas are two types of psychological causes. Learned helplessness includes beliefs on the part of individuals that they have no control over their own outcome. Negative self-schemas are negative conceptions of ones own traits, abilities, and behaviors. Many people suffering from mood disorders seek suicide. Suicide rates vary with age, nation, and culture. Slide 7 Anxiety Disorders: When Dread Debilitates Please go to slide # 7 Anxiety is a vague concern that something unpleasant will soon occur. We all experience anxiety at one time or another, but if such feelings become intense and persist for long periods of time, they can constitute anxiety disorders. Lets look at four types of anxiety disorders. Phobias are excessive fears that cause intense emotional distress and significantly interfere with everyday activities. There are many phobias, but the majority involves the fear of animals, the natural environment, blood illness and injections, and various situations. For example, social phobia is an excessive fear of situations in which a person may be evaluated and embarrassed. One possible cause of phobias is classical conditioning, which we already discussed in Lesson Three. Through conditioning, stimuli that dont initially elicit strong emotional reactions can ultimately do so. Another type of anxiety disorder is panic disorder, which includes periodic, unexpected attacks of intense, terrifying anxiety. Although panic attacks often seem /var/www/apps/conversion/current/tmp/scratch_6/112226067.doc Chapter 12 Week 8: 2/26-3/2/07 Page 5 of 17

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to occur without a specific trigger, they often take place in specific situations and are associated with agoraphobia intense fear of open spaces, being in public, or traveling. Existing evidence indicates that both biological and cognitive factors contribute to panic disorders. The third type of anxiety disorder we will discuss is obsessive-compulsive disorder in which individuals have recurrent, disturbing thoughts they cannot prevent unless they engage in specific behavior. Among the most common obsessions include the fear of dirt or germs, disgust over body waste, undue concern that they have not done a job adequately, and fear of having antireligious or sexual thoughts. Common compulsions, or actions people perform to neutralize obsessions, include repetitive hand washing, counting objects a precise number of times, repeating an action a specific number of times, and hoarding useless objects. Performing such actions reduces the anxiety caused by their obsessions. The last type of anxiety disorder we will discuss is posttraumatic stress disorder, or PTSD. Some persons exposed to traumatic events experience PTSD in which they: Persistently re-experience the traumatic event in their thoughts or dreams; Occasionally feel as if they are reliving the event; Persistently avoid stimuli associated with the event; and Persistently experience symptoms of increased arousal. Not all persons exposed to a trauma experience PTSD after exposure to a frightening event due to several factors the amount of social support they receive after the event, the coping strategies used, and cognitive factors such as how people think about and interpret trauma. Please go to slide # 8

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Slide 8

Dissociative Disorders

Another form of mental disorder on the DSM-IV includes dissociative disorders, which involve prolonged loss of memory or identity. Three forms of dissociative disorders include dissociative amnesia, dissociative fugue, and dissociative identity disorder. In dissociative amnesia, individuals suddenly experience a loss of memory that doesnt stem from medical conditions or other mental disorders. In dissociative fugue, an individual suddenly wanders off, adopts a new identity, and is unable to recall his or her own past. The most controversial disorder is the dissociative identity disorder, previously referred to as multiple personality disorder, in which a single person seems to possess two or more distinct identities that take control of the persons behavior at different times. Typically, there is one host personality and one or more alters. Please go to slide # 9 Somatoform disorders are also listed on the DSM-IV. These are disorders in which individuals have physical symptoms without identifiable physical causes. A common somatoform disorder is hypochondriasis, which is preoccupation with fear about having a serious disease. Hypochondriacs do not actually have the diseases they fear, but they persistently worry about them and feel the reported pain or discomfort. Another type of somatoform disorder is conversion disorder, in which individuals actually experience physical problems such as motor and sensory deficits. Although the disabilities are real to the individual, there is no medical condition that would produce them. A number of factors play a role in the occurrence of somatoform disorders. Individuals who develop somatoform disorders seem to have a tendency to focus on inner sensations, perceive normal bodily sensations as more intense than most people, and have a high level of negative affectivity. Please go to slide # 10

Slide 9

Somatoform Disorders: Physical Symptoms without Physical Causes

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Slide 10

Sexual & Gender Identity Disorders

The DSM-IV also lists sexual and gender identity disorders. Sexual disorders include sexual dysfunctions, such as sexual desire and sexual arousal disorders, and paraphilias. Sexual desire disorders involve a lack of interest in sex or active aversion to sexual activity, whereas sexual arousal disorders involve the inability to attain or maintain an erection or the absence of vaginal swelling and lubrication. Paraphilias are disorders in which sexual arousal cannot occur without the presence of unusual imagery or acts. Types of paraphilias include frotteurism, pedophilia, sexual sadism, and sexual masochism. Gender identity disorder occurs when individuals believe that they were born with the wrong sexual identity. In the past, there was little medicine and technology to satisfy individuals suffering from gender identity disorder. However, advances in surgical techniques make it possible for such individuals to undergo sex-change operations in which their sexual organs are altered to approximate those of the other gender.

Slide 11

Personality Disorders: Traits that Harm

Please go to slide # 11 Personality disorders, as defined by the DSM-IV, include extreme and inflexible personality traits that are distressing to the individuals who have them and cause them problems in school, work, or interpersonal relationships. Personality disorders are divided into three distinct clusters. The first cluster involves odd, eccentric behavior or traits and includes three personality disorders paranoid, schizoid, and schizotypal. Individuals suffering from paranoid personality disorders believe that everyone is out to get them, deceive them, or take advantage of them in some way. Individuals suffering from schizoid personality disorders show little or no sign of emotion and lack basic social skills. The schizotypal personality disorder also shows a pattern of social isolation and avoidance of close relationships. Schizotypal individuals are highly anxious in social situations and often act in bizarre or strange ways. The other two clusters of personality disorders include those involving dramatic, emotional, and erratic forms of behavior, and disorders involving anxious fearful behavior. Existing evidence suggests

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that both genetic and environmental factors contribute to antisocial personality disorder. Slide 12 Schizophrenia: Losing Touch with Reality Please go to slide # 12 Schizophrenia is a serious mental disorder defined as a complex disorder characterized by fragmentation of basic psychological functions. As a result of fragmentation, individuals with schizophrenia have serious problems in adjusting to the demands of reality. The major symptoms of this disorder are often divided into positive and negative symptoms. Positive symptoms involve adding something that isnt normally there, whereas negative symptoms involve the absence or reduction in normal functions. Lets look at each of these types of symptoms in more detail. Positive symptoms of schizophrenia include delusions, hallucinations, disordered thought processes, and disordered behaviors. Delusions involve misinterpretations of normal events and experiences, and can take many different forms. Two common types of delusions are delusions of persecution and delusions of grandeur. Delusions of persecution is the belief that one is being plotted against, spied on, threatened, or mistreated. Delusions of grandeur is the belief that one is extremely famous, important, or powerful. Hallucinations occur when individuals see or hear things that arent actually there. Negative symptoms of schizophrenia include the flat affect and avolition. Individuals with the flat affect symptom show no emotion. Conversely, some schizophrenics do show emotion, but with inappropriate reactions. Avolition is the total lack of motivation or will. There are many contributing factors to schizophrenia genetic, neurodevelopmental, biochemical, psychological, and environmental. Although schizophrenia doesnt appear to be traceable to a single gene, research suggests that many genes and environmental factors operate together to produce a tendency toward this disorder. Also, schizophrenia tends to run in families. One neurodevelopmental factor is the disruption in normal brain development, /var/www/apps/conversion/current/tmp/scratch_6/112226067.doc Chapter 12 Week 8: 2/26-3/2/07 Page 9 of 17

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including dysfunction that develops before birth. For example, several studies indicate that damage to the brain resulting from oxygen deprivation, both before and during birth, can increase the likelihood of schizophrenia later in life. Biochemical factors, including the disturbance in the functioning of certain neurotransmitters, may contribute to schizophrenia. The last factor environmental also plays an important part in the development of schizophrenia. Research on relapses suggest that patients are more likely to suffer relapses when their families adopt patterns of harsh and hostile expressions. Slide 13 Please go to slide # 13 Substance-Related An additional group of disorders is substance related Disorders disorders, divided into two categories. Substanceinduced disorders impair functioning as a direct result of the physiological effects of the substance in question. Substance-use disorders are those in which frequent use of substances result in harmful behaviors or impairments in personal, social, and occupational functioning. Evidence suggests that substance-abuse disorders are among the most damaging of all disorders described in the DSM-IV. According to the DSM-IV, substance abuse is the maladaptive pattern of substance use that results in repeated, significant adverse effects and maladaptive behaviors such as: Failure to meet obligations at work, school or at home; Repeated use of a psychoactive substance in hazardous ways; Recurrent legal problems related to the substance; and Continued use of the substance despite its negative effects. Although alcohol is the most frequently abused substance, it is not the only abused psychoactive substance. Nicotine, heroin, cocaine, and crack also contribute to substance-abuse disorders. Also, since they stem from many different factors biological, social, and personal they are often very difficult to treat. /var/www/apps/conversion/current/tmp/scratch_6/112226067.doc Chapter 12 Week 8: 2/26-3/2/07 Page 10 of 17

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Please go to slide # 14

Slide 14

Psychotherapies: Psychological Approaches to Mental Disorders

Although mental disorders take many forms and produce great suffering for large numbers of individuals, mental health professionals have developed many ways of alleviating the symptoms and reducing or eliminating their causes. These forms of therapy include psychotherapies, group setting therapy, and biological therapies. Lets take a look at psychotherapies on this slide. Psychotherapies are procedures in which persons with mental disorders interact with trained therapists who help them change certain behaviors, thoughts, or emotions in order to feel and function better. Psychodynamic therapies are based on the idea that mental disorders primarily stem from the kind of inner conflicts first described by Freud, which you learned about in a previous lesson. Psychodynamic therapies assume that mental disorders occur because something has gone wrong in the balance between these inner forces.

The most famous form of therapy based on psychodynamic assumptions is psychoanalysis, developed by Freud. Psychoanalysis focuses on helping individuals gain insight into their hidden inner conflicts and repressed wishes. Although there is little support for this view, Freud believed that once awareness of these conflicts penetrated patients defense mechanisms and became conscious, their disorders would fade away. Freud also noted several events of psychoanalysis. The first is resistance a /var/www/apps/conversion/current/tmp/scratch_6/112226067.doc Chapter 12 Week 8: 2/26-3/2/07 Page 11 of 17 10/2/2012

patients stubborn refusal to report certain thoughts, motives, and experiences or overt rejection of the analysts interpretations. The other event is transference intense feelings of love or hate toward the analyst on the part of the patients. Psychoanalysis suffers from several major weaknesses and is not a popular form of therapy today. Another form of psychotherapy is phenomenological or experiential therapies. These humanistic therapies are based on the ideas that understanding other people requires trying to see the world through their eyes and that the therapeutic relationship with the client is central to achieving benefits in therapy. Unlike psychoanalysis, humanistic therapists believe that clients, not they, must take responsibility for the success of therapy. Client-centered therapy, developed by Carl Rogers, is one type of humanistic approach. This type of therapy focuses on eliminating unrealistic conditions of worth through the creation of a psychological climate in which clients feel valued as persons. Gestalt therapy, developed by Fritz Perls, is another type of humanistic approach which suggests that many people have difficulties in directly experiencing and expressing emotions, resulting in manipulative social games or roles. The focus of Gestalt therapy is to help clients become aware of the feelings and needs they have disowned, and to recognize that these are a genuine part of themselves. Often, Gestalt therapists use the empty chair technique to allow clients to re-experience old hurts, jealousies, fears, and resentments in order to realize their true feelings. Please go to slide # 15 to learn about the two remaining types of psychotherapies.

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Slide 15

Psychotherapies: Psychological Approaches to Mental Disorders Continued

In contrast to psychodynamic and phenomenological therapies, behavior therapies primarily focus on individuals current behavior. These therapies are based on the belief that the persons involved have either failed to acquire the skills and behaviors needed to cope with problems of daily life, or they have acquired maladaptive habits and reactions. Behavior therapies employ techniques based on major kinds of learning classical conditioning, operant conditioning, and modeling. Another important approach to psychotherapy is cognitive therapies, which are based on the view that many mental disorders stem from faulty or distorted modes of thought. Two types of cognitive therapies are rational-emotive therapy and Becks cognitive behavior therapy. Rational-emotive therapists attempt to persuade clients to recognize their own irrational thoughts, whereas Becks cognitive behavior therapy is designed to change cognitive tendencies, such as illogical ideas, that contribute to depression.

Slide 16

Alternatives to Individual Psychotherapy: Group Therapy

Please go to slide # 16 An alternative to individual psychotherapy is group therapy, including marital and family therapies. All group therapies involve procedures in which several people discuss their problems with one another under the guidance of a trained therapist. Both marital and family therapy assume that one reason many individuals experience personal problems is poor or faulty relations with important persons in their lives. Therefore, group therapies adopt an interpersonal perspective rather than one focused primarily on individuals. Marital therapy focuses on helping couples who feel that their marriages are worth saving. The number one reason couples seek therapy is perceived unfairness in their division of labor each believes the other isnt doing his or her fair share of work. Another underlying cause of many marital conflicts is faulty communication. One type of marital therapy is behavior marital therapy, which focuses on changing communication problems. Some of the techniques used in behavior marital therapy include role playing and watching videotapes of the couples interactions. Once

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good communication is established, couples may find it easier to resolve the other sources of marital problems. Please go to slide # 17

Slide 17

Biological Therapies

Biological therapies attempt to alleviate mental disorders through biological means such as antipsychotic drugs, antidepressant drugs, lithium, antianxiety drugs, electroconvulsive therapy, and psychosurgery. Lets take a closer look at each of these. Antipsychotic drugs, sometimes referred to as the major tranquilizers or neuroleptics, are highly effective in reducing the positive symptoms shown by schizophrenics, but less effective in reducing negative symptoms. Some antipsychotic drugs block the action of dopamine on certain receptors in the brain, whereas others influence many different chemicals in the brain. Although these drugs are very effective in reducing the symptoms of schizophrenia, there are many drawbacks blurred vision, dry mouth, uncontrollable muscle contractions, agitation, and tardive dyskinesia. The most serious side effect of all, tardive dyskinesia involves the loss of motor control, especially in the face.

Antidepressant drugs include three basic types selective serotonin reuptake inhibitors, or SSRIs, MAO inhibitors, and tricyclics. Similar to most drugs used to treat mental disorders, antidepressant drugs seem to exert their effects by influencing neurotransmitters. The most famous and commonly prescribed antidepressant is Prozac, which is among the SSRIs. Like other antidepressant drugs, Prozac appears to have serious side effects such as nervousness, insomnia, joint /var/www/apps/conversion/current/tmp/scratch_6/112226067.doc Chapter 12 Week 8: 2/26-3/2/07 Page 14 of 17 10/2/2012

pain, weight loss, and sexual dysfunction. MAO inhibitors are used less often than other types of antidepressants because they can produce more dangerous side effects elimination of REM sleep, rise in blood pressure, and risk for stroke. Tricyclics also produce side effects such as disturbances in sleep and appetite, but tend to decrease within a few weeks. Lithium is generally administered along with antipsychotic or antidepressant medications. Although effective in treating bipolar disorder, lithium has serious side effects including delirium and death. The most widely prescribed antianxiety drugs are benzodiazephines Valium, Ativan, Xanax, and Librium. These drugs seem to produce their effects by acting as a braking system for the nervous system, reducing anxious or tense activity. Although they are effective, they also have serous side effects drowsiness, dizziness, fatigue, and reduced motor coordination. Another form of biological therapy is electroconvulsive therapy, or ECT, which involves placing electrodes on the patients temples and delivering shocks of seventy to one hundred thirty volts for brief intervals. The shocks are continued until the patient has a seizure lasting at least twenty to twenty-five seconds. Treatment typically lasts between a week to several weeks. ETC seems to work for some disorders, but has serious risks such as loss of episodic memory. Psychosurgery is a type of biological therapy involving brain operations designed to change abnormal behavior. One type of psychosurgery includes prefrontal lobotomies, which are rarely done today. However, limited operations on the brain continue. For example, cingulotomy severs connections between a very small area of the brain and the limbic system. Even newer procedures involve inserting a tiny video camera into the brain or using computer-guided imagery. Please go to slide # 18

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Slide 18

Summary

We have now reached the end of Lesson Eight. Lets briefly review what was covered in this half of the lesson. The first topic discussed was assessment a set of information-gathering steps a psychologist follows when seeing a patient for the first time. An accurate diagnosis is formulated by comparing the gathered information to standard definitions of various mental disorders listed in the Diagnostic and Statistical Manual of Mental Disorders-four, or DSM-IV. The DSM-IV classifies mental disorders along five axes or dimensions. The different axes relate to mental disorders, physical health, and social and occupational functioning. The basis of this lesson stemmed from the two axes shown here. First we discussed childhood and adolescent disorders. We looked at: Disruptive behavior, which is divided into two major categories oppositional defiant disorder and conduct disorder; Attention-deficit/hyperactivity disorder; Feeding and eating disorders including anorexia nervosa and bulimia nervosa; and Pervasive development disorders, such as autism. The second topic discussed was mood disorders, including depression and bipolar disorder. Next we discussed four types of anxiety disorders phobias, panic disorder, obsessive-compulsive disorder, and posttraumatic stress disorder. Dissociative disorders involve prolonged loss of memory or identity. Three forms of dissociative disorders include dissociative amnesia, dissociative fugue, and dissociative identity disorder. Somatoform disorders, including hypochondriasis and conversion disorder, are disorders in which individuals have physical symptoms without identifiable physical causes. Individuals who develop somatoform disorders seem to have a tendency to focus on inner sensations, perceive normal bodily sensations as more intense than

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most people, and have a high level of negative affectivity. Personality disorders, as defined by the DSM-IV, include extreme and inflexible personality traits that are distressing to the individuals who have them and cause them problems in school, work, or interpersonal relationships. Personality disorders are divided into three distinct clusters. We focused on the first cluster which involves odd, eccentric behavior or traits and includes three personality disorders paranoid, schizoid, and schizotypal. Schizophrenia is a serious mental disorder defined as a complex disorder characterized by fragmentation of basic psychological functions. The major symptoms of this disorder are often divided into positive and negative symptoms. Positive symptoms involve adding something that isnt normally there, whereas negative symptoms involve the absence or reduction in normal functions. Although mental disorders take many forms and produce great suffering for large numbers of individuals, mental health professionals have developed many ways of alleviating the symptoms and reducing or eliminating their causes. These forms of therapy include psychotherapies, group setting therapy, and biological therapies. This completes Lesson Eight.

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