Psychological Disorders Definition, diagnosis and treatment

What constitutes a disorder? Behavior is ___________

Understanding psychological disorders through the ages Ancient Greece: imbalance of the “four humours” Dark ages-Middle ages: devil or witchcraft 18th century: medical (biological) model of disease 20th century: biopsychosocial model of psychological disorders

Classification of disorders DSM-IV-TR - diagnostic manuals used by clinicians Symptoms Labels Prognoses Sample cases Statistics

Anxiety disorders Characterized by feelings of excessive apprehension and anxiety Generalized anxiety disorder Phobic disorders Panic disorder Obsessive-compulsive disorder Post-traumatic stress disorder

Generalized Anxiety disorder Symptoms - Prevalence Treatment

Phobic disorders Persistent and irrational fears Social phobias Specific phobias Acrophobia, claustrophobia, hemophobia, pyrophobia, triskadekaphobia, ophidiophobia, astraphobia, nyctophobia, aichmophobia, coulrophobia, trichophobia…

Treatment for phobias Exposure Classical Conditioning Rationale Systematic Desensitization Flooding Imaginal vs. In Vivo Classical Conditioning Rationale Anxiety hierarchy Subjective Units of Distress (SUDS) Response prevention Safety Cues

Panic disorder Panic attacks Symptoms Not: May result in agoraphobia

Treatment for Panic Disorder Exposure is still used, but this time the cue for the fear is _________________. Hypervigilance Exposure Techniques: Breathing Retraining and Muscle Relaxation

Obsessive-Compulsive disorder Persistent obsessions and compulsions Obsession = Compulsion =

Treating OCD Exposure with Ritual Prevention Cognitive Restructuring Operational conditioning of fear through avoidance Self Monitoring Block compulsion responses to anxiety Cognitive Restructuring Catastrophic Thinking Psychopharmacology Clomipramine (anafranil). Fluoxetine (prozac), Fluvoxamine (luvox)

Post-Traumatic Stress disorder Result of severe trauma and emotional distress. Symptoms Lasting 4+ weeks Relies on (lack of) emotional resilience

Treating PTSD Prolonged Exposure Expose to memories and cues related to trauma Imaginal: recite memories in first person repeatedly until SUDS go down. In vivo: spend time in similar environments that create anxiety related to the trauma

Treatment for anxiety disorders Biological Antianxiety drugs Antidepressant drugs D-Cycloserine Cognitive Cognitive-behavior therapy Behavioral Exposure therapy Systematic desensitization

Mood disorders Disorders characterized by emotional extremes Major depressive disorder Bipolar disorder

Major Depressive disorder Overwhelming sadness, hopelessness and loss of interest Symptoms Emotional Cognitive Motivational Somatic Symptoms last 2+ weeks Prevalence

Treating Depression Albert Ellis – Cognitive Therapy Confronting Irrational Thinking Beck – Cognitive Behavioral Therapy Socratic Dialogue Thought Records Event – Feelings – Cognitions – Other interpretations Cognitive Restructuring Collaborative Empiricism Behavioral Homework Assignments Scheduling Activities (Mastery, Pleasure, Tests) Jacobson – Behavioral Activation Increase opportunities for reinforcement Overgeneralizing Selective abstraction (only failure matters) Excessive responsibility Assuming temporal causality Self references- Everyone notices how bad I am Catastrophizing Dichotomous

Bipolar disorder Characterized by wide swings between two emotional extremes Mania Depression Cyclic switching between moods Treatment – Lithium and behavioral therapies

Treatment for mood disorders Biological Antidepressants (depression) Mood stabilizers (bipolar) Electroconvulsive therapy (depression) Deep-brain stimulation (depression) Transcranial magnetic stimulation (depression) Psychotherapy Cognitive-behavioral therapy Psychodynamic/Interpersonal therapy

Personality disorders Maladaptive behaviors which impair social functioning Antisocial personality disorder Borderline personality disorder

Antisocial personality disorder Marked by a lack of conscience and malicious behavior patterns Symptoms Prevalence Low in ______________ population, high in _______________ populations

Antisocial personality disorder Associated with reduced cortical volume and activation of the frontal cortex Also associated with low levels of stress hormones and arousal

Borderline personality disorder Unstable personality, mood, identity and behavior Symptoms Emotional instability Impulsivity Unstable identity Fear of abandonment Paranoid ideation Prevalence 3:1 Females:Males

Treating BPD Linehan - Dialectical Behavior Therapy Individual Therapy Acceptance-Change dialectic Group Skills Training Emotion Regulation Distress Tolerance Interpersonal Effectiveness Mindfulness Therapist Consult Team 24 Hour Phone Consultation

Schizophrenia Split from reality Disorganization of thought, perceptions, emotions and behaviors Prevalence

Schizophrenia Symptoms Positive Negative Thought disorder Hallucinations Delusions Negative Flat affect Lack of motivation Decline in communication and interaction

Schizophrenia Dopamine hypothesis - excess of DA causes positive symptoms Prenatal factors Virus Stress Environmental or developmental factor influences onset

Treatment for Schizophrenia Biological Antipsychotic drugs Reduce dopamine Long-term consequences Behavioral Operant conditioning Token economy