Psychological Disorders Part II

Mood Disorders *Psychological disorders characterized by emotional extremes. Come in two principal forms: 1.Major Depressive Disorder 2.Bipolar Disorder (manic-depressive disorder) There are several different types of mood disorders that are not classified in the DSM… –Postpartum Depression –Seasonal Affective Disorder *Why? Not everyone agrees on how to characterize and define these forms of depression

Major Depressive Disorder Although phobias are more common, depression is the #1 reason people seek mental health services. Leading cause of disability worldwide (WHO, 2002)…in any given year, depression plagues 5.8% of men & 9.5 % of women. Major Depressive Disorder occurs when at least 5 signs of depression (incl. lethargy, feelings of worthlessness, or loss of interest in family/friends/activities) last 2 or more weeks & are not caused by drugs or medical condition; Disabling disorder needing treatment. Dysthymic Disorder is a depressive state lasting more than 2 yrs. (1 yr. kids); patients present 2 or more of the following: poor appetite/overeating, insomnia/hypersomnia, low energy or fatigue, low self- esteem, poor concentration or difficulty making decisions, feelings of hopelessness.

Bipolar Disorder - (formerly manic-depressive disorder) *Mood disorder in which person alternates btwn hopelessness & lethargy of depression & the overexcited state of mania. During the manic phase, typically overtalkative, overactive & elated; have little need for sleep; & show fewer sexual inhibitions; reckless spending is common or unsafe sex. Before long, the elated mood plunges into depression. Historically many creative artists had bipolar disorder: Walt Whitman, Virginia Woolf, Samuel Clemens (Mark Twain) & Ernest Hemingway.

Understanding Mood Disorders Any theory of depression must explain the following: –Many behavioral & cognitive changes accompany depression –Depression is widespread –Compared with men, women are nearly twice as vulnerable to major depression –Most major depressive episodes self-terminate –Stressful events related to work, marriage, and close relationships often precede depression –With each new generation, depression is striking earlier (now often in the late teens) & affecting more people.

The Biological Perspective: –Genetic Influences: The heritability of major depression is 35-40%; Mood disorders run in families –The Brain: Less activity in brain during slowed- down depressive states & more activity during mania; Left frontal lobe (active during positive emotions) inactive during depressed states; MRI scans fount frontal lobes of major depressives 7% smaller; the hippocampus vulnerable to stress related damage. –Biochemical Influence: norepinephrine increases arousal & boosts mood is scarce during depression & overabundant during mania; serotonin scarce during depression

Social-Cognitive Perspective: –Explores the roles of thinking and acting –Intensely negative assumptions about themselves, their situation, & their future lead them to magnify bad experiences & minimize good ones…self- defeating beliefs & a negative explanatory style feed depression’s vicious cycle. –Depression’s Vicious Cycle: 1.Stressful experiences 2.Negative explanatory style 3.Depressed mood 4.Cognitive & behavioral changes

Schizophrenia *A group of severe disorders characterized by disorganized & delusional thinking, disturbed perceptions, & inappropriate emotions & actions Literally means “split mind” referring not to split personality but a split from reality. Nearly 1 in 100 people will develop schizophrenia. Est. 24 million worldwide who suffer one of humanity’s most dreaded disorders (WHO, 2008).

Symptoms of Schizophrenia Disorganized Thinking: –Thinking is fragmented, bizarre & often distorted by false beliefs called delusions. –Those with paranoid tendencies are particularly prone to delusions of persecution. Disturbed Perceptions: –May have hallucinations (sensory experiences w/o sensory stimulation), seeing, feeling, tasting, or smelling things that are not there; most often auditory. Inappropriate Emotions & Actions: –Often utterly inappropriate, split off from reality; i.e.: laughing at grandmother’s death; crying while others laugh, etc. –Others lapse into emotionless state or flat affect. –Motor behavior also inappropriate; some perform senseless, compulsive acts (rocking/rubbing arm) –Others may exhibit catatonia, may remain motionless for hours or days

August Natterer, “Witch’s Head”

Onset & Development of Schizophrenia The diagnosis occurs btwn 15 –30 yrs. Incidence in males & females is about equal, though men tend to be struck earlier, more severely & just slightly more often. For some, the disorder appears suddenly & for others it develops gradually, emerging from a long history of social inadequacy. Schizophrenia is actually a cluster of disorders; The subtypes share some common features, but they also have some distinguishing symptoms…

Patients with positive symptoms may have hallucinations, talk in disorganized/deluded ways & show inappropriate laughter/tears/rage; Thus the presence of inappropriate behaviors. Patients with negative symptoms have toneless voices, expressionless faces, or mute/rigid bodies; The absence of appropriate behaviors. One rule holds true around the world: When it’s a slow-developing process (chronic or process schiz.), recovery is doubtful b/c they often exhibit negative symptoms. When previously well adjusted people develop schizophrenia rapidly (acute or reactive schiz.) recovery is more likely; positive symptoms respond better to drug therapy.

Subtypes of Schizophrenia Paranoid: preoccupation w/ delusions or hallucinations, often w/ themes of persecution or grandiosity. Disorganized: disorganized speech or behavior, or flat or inappropriate emotion. Catatonic: Immobility (or excessive, purposeless movement), extreme negativism, and/or parrotlike repeating of another’s speech or movements. Undifferentiated: Many & varied symptoms Residual: Withdrawal, after hallucinations & delusions have disappeared