PSYCHOPATHOLOGY DIAGNOSIS AND TREATMENT STRATEGIES

2 InRev15a ANXIETY, SOMATOFORM, AND DISSOCIATIVE DISORDERS Phobias Generalized anxiety disorder Panic disorder Obsessive-compulsive disorder Conversion disorder Hypochondriasis Somatization disorder Pain disorder Amnesia/fugue Dissociative identity disorder (multiple personality disorder) Disorder Anxiety disorders Somatoform disorders Dissociative disorders SubtypesMajor Symptoms Intense, irrational fear of objectively nondangerous situations or things, leading to disruptions of behavior. Excessive anxiety not focused on a specific situation or object; free- floating anxiety. Repeated attacks of intense fear involving physical symptoms such as faintness, dizziness, and nausea. Persistent ideas or worries accompanied by ritualistic behaviors performed to neutralize the anxiety-driven thoughts. A loss of physical ability (e.g., sight, hearing) that is related to psychological factors. Preoccupation with or belief that one has serious illness in the absence of any physical evidence. Wide variety of somatic complaints that occur over several years and are not the result of a known physical disorder. Preoccupation with pain in the absence of physical reasons for the pain. Sudden, unexpected loss of memory, which may result in relocation and the assumption of a new identity. Appearance within same person of two or more distinct identities, each with a unique way of thinking and behaving.

3 ANXIETY DISORDERS u PANIC DISORDER u GENERALIZED ANXIETY DISORDER u PHOBIAS u OBSESSIVE-COMPULSIVE DISORDER u POST-TRAUMATIC STRESS DISORDER

4 A. Panic Disorder experience reoccurring episodes of anxiety attacks; unpredictable; some situations might become related to it. Anxiety attack; 5 needed may last a couple of minutes to hoursheart palpitations, tense muscles, especially chest muscles which are often misinterpreted for heart attack, choking sensation from tight neck muscles, faint or dizzy feeling, increase sweat, hot or cold flashes.A. Panic Disorder experience reoccurring episodes of anxiety attacks; unpredictable; some situations might become related to it. Anxiety attack; 5 needed may last a couple of minutes to hoursheart palpitations, tense muscles, especially chest muscles which are often misinterpreted for heart attack, choking sensation from tight neck muscles, faint or dizzy feeling, increase sweat, hot or cold flashes. PANIC DISORDER Experience reoccurring episodes of anxiety attacks; unpredictable; some situations might become related to it. Anxiety attack: 5 needed may last a couple of minutes to hours heart palpitations tense muscles, especially chest muscles often misinterpreted for heart attack, choking sensation from tight neck muscles, faint or dizzy feeling, increase sweat, hot or cold flashes.

5 GENERALIZED ANXIETY DISORDER Persistent level of anxiety lasting at least one month Symptoms: Motor: Tension of muscles: shakes, tremble, unable to relax, twitch, startle easily Autonomic hyperactivity: Sweat, increased heart rate, cold hands, hot, cold flashes, light headed and dizzy Apprehension--worry constantly Vigilance and scanning: hyperattentive to things in the environment, distractible, hard to concentrate, impatient, irritable.

6 PHOBIA Irrational fear response of specific stimuli SOCIAL PHOBIAS AGORAPHOBIA SPECIFIC PHOBIAS

7 OBSESSIVE-COMPULSIVE DISORDER Marked by overt ritualistic behavior and persistent intruding thoughts Occurs at a frequency so high as to interfere with daily functioning

8 SOMATOFORM DISORDERS u HYPOCHONDRIASIS u CONVERSION HYSTERIA

9 HYPOCHONDRIASIS Preoccupation with body and illness No relief if given healthy diagnosis Just as tense--travel and search for new physicians

10 CONVERSION DISORDER Individual has dramatic physical symptoms with no organic cause. 1. Paralysis of legs/arms/ total 2. Anesthesia--lost sense of touch with parts of body 3. Analgesia--feel no pain 4. Other common experiences: nausea, lower back pain, dizziness, hysterical blindness, deafness, unexplained headaches 5. Unusually INDIFFERENT to symptoms 6.Secondary gain for having symptoms 7. May disappear while asleep or under hypnosis 8. Craft Paralysis: symptoms selective to job--paralyzed hands of violinist or tennis player. 9. Symptoms make no common sense neurologically

11 DISSOCIATIVE DISORDERS u DISSOCIATIVE AMNESIA u DISSOCIATIVE FUGUE u DISSOCIATIVE IDENTITY DISORDER

12 DISSOCIATIVE AMNESIA Memory for certain events from 1 hour to 3 months is lost Person is not distressed by loss of memory-- intellectual and skills still there. Theorized as a loss of memory (repression) for traumatic event

13 DISSOCIATIVE FUGUE Amnesia for entire life & self Starts a new life in a new location -called travelling amnesiac Cause: extreme stress & need to flee Can last for days, weeks, years. Extremely rare except on Soaps!

14 DISSOCIATIVE IDENTITY DISORDER Dominance of 2 or more distinct personalities Generally amnesic for existence of others Controversial Diagnosis

Diathesis Stress Model of Disorders Fig131

16 AFFECTIVE DISORDERS u MAJOR DEPRESSION u DYSTHYMIC DISORDER u BIPOLAR DISORDER u CYCLOTHYMIC DISORDER u SEASONAL AFFECTIVE DISORDER

17 CLINICAL DEPRESSION Emotions major disturbing problem but also problem in cognition (self- defeating thoughts) 1. Dysphoric mood for a minimum of 2 weeks plus 4 of following: Change in appetite usually decrease Change in sleep--insomnia or hypersomnia Change in amount of psychomotor activity-slow or agitated Fatigue or loss of energy Feelings of worthlessness, self critical or inappropriate guilt Poor concentration Suicide or suicidal ideation

18 BIPOLAR DISORDER MANIC-DEPRESSION Elevated mood-elation and mania alternating with depressive thoughts Mania: inflated self esteem: too self confident talkative w/flight of ideas increased activity, interests, social decreased need of sleep, distracted concern that will harm selves not judge consequences of actions shopping spree--self destructive buying pattern

19 INCIDENCE OF DEPRESSION Fig Risk Prevalence in general population Fraternal twins Major depression Identical twins Bipolar disorder Prevalence in general population Fraternal twins Identical twins

20 Creativity and Madness

21 SCHIZOPHRENIA u PARANOID u CATATONIA u DISORGANIZED HEBEPHRENIA u SIMPLE u RESIDUAL

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23 Fig15_5 15_05 Low Min Max High Challenging events C A Normal behavior Schizophrenic behavior D B Vulnerability Threshold

24 PERSONALITY DISORDERS

25 Tab15_5 Fig15_5 Paranoid Schizoid Schizotypal Depedent Obsessive- compulsive Avoidant Histrionic Narcissistic Borderline Antisocial TypeTypical Features Suspiciousness and distrust of others, all of whom are assumed to be hostile. Detachment from social relationship; restricted range of emotion. Detachment from, and great discomfort in, social relationships; odd perceptions, thoughts, beliefs, and behaviors. Helplessness; excessive need to betaken care of; submissive and clinging behavior; difficulty in making decisions. Preoccupation with orderliness, perfection, and control. Inhibition in social situations; feelings of inadequacy; oversensitivity to criticism. Excessive emotionality and preoccupation with being the center of attention; emotional shallowness; overly dramatic behavior. Exaggerated ideas of self-importance and achievements; preoccupation with fantasies of success; arrogance. Lack of stability in interpersonal relationships, self-image, and emotion; impulsivity; angry outbursts; intense fear of abandonment; recurring suicidal gestures. Shameless disregard for, and violation of, other people's rights.

26 PSYCHO-SEXUAL DISORDERS Fetishism Zoophilia Sadism Masochism Exhibitionism Pedophilia

27 DEVELOPMENTAL DISORDERS Autism Academic Skills Disorder Attention Deficit Disorder w/hyperactivity Senile Dementia

TREATMENT PSYCHOANALYSIS BEHAVIOR HUMANISTIC COGNITIVE BIOMEDICAL

29 SIGMUND FREUD PSYCHOANALYSIS Resistance Catharsis Transference Interpretation Insight

30 DEINSTITUTIONALIZATION

32 CARL ROGERS CLIENT CENTERED

33 HUMANISTIC THERAPY

34 ROLLO MAY EXISTENTIAL THERAPY

35 ALBERT BANDURA MODELING

36 BEHAVIOR AND COGNITIVE

37

38 ELECTRO-CONVULSIVE SHOCK TREATMENT (ECT) u Single most effective treatment for psychotic depression u Used as treatment of last resort u Actual understanding of how it works is not complete--disrupts electrical impulses of brain u Within two to four weeks many see profound mood elevation u Side Effects include memory loss (usually short term)

39 PSYCHOSURGERY  PREFRONTAL LOBOTOMY  Removal of brain tissue to relieve symptoms  Pre-frontal lobotomy first used on gorillas and found to calm aggression; applied to patients in mental institutions beginning in the 1950’s  Often used on schizophrenics bringing flat affect  Today smaller amount of tissue can be removed from specific areas showing malfunction--cingulotomy  Can be very effective at removing tumor and other tissue causing abnormal behaviors

40 BIOMEDICAL TREATMENTS u Drug Treatment Options: u Anti-Anxiety Xanax u GABA neurotransmitter u Anti-Depressant drugs Prozac u Serotonin and Norepinephrine u Anti-Psychotic drugs Thorazine u Dopamine

PSYCHOTHERAPY VS NONE41 Number of people No improvementOutstanding improvement Average untreated person Average treated person 80% of untreated persons