2. Unit 7: Health & Adjustment Psychological Illness & Treatment
Day 1: Background, Diagnosis, Anxiety, Depression, and Mood Disorders

3. Learning Objectives
Obtain an understanding of Psychological Disorders and how we diagnose them.
Explore Anxiety, Depressive, and Mood Disorders.

4. Defining Disorder

5. Defining Psychological Disorders
Psychological disorders: A syndrome marked by a clinically significant disturbance in an individual’s cognition, emotion regulation, or behavior.
Disturbed behavior
Dysfunctional behavior
Maladaptive behavior
What makes a Behavior a Mental Illness - The Four Ds”
Deviance – Different, extreme, unusual
Distress – Unpleasant & upsetting
Dysfunction – Causes interference with life
Danger – Poses risk of harm

6. National Institute of Mental Health Statistics
An estimated 26.2 percent of Americans ages 18 and older — about one in four adults — suffer from a diagnosable mental disorder in a given year. Or million people.
About 6 percent, or 1 in 17 —suffer from a serious mental illness.
In addition, mental disorders are the leading cause of disability in the U.S. and Canada for ages
Nearly half (45 percent) of those with any mental disorder meet criteria for 2 or more disorders, with severity strongly related to comorbidity.
Most common disorders were anxiety, phobias, and mood disorders

7. Increasingly Common Diagnosis
Attention-Deficit Hyperactivity Disorder (ADHD) A psychological disorder marked by the appearance by age 7 of one or more of three key symptoms; extreme inattention, hyperactivity, and impulsivity.

8. Understanding Psychological Disorders The Medical Model
Philippe Pinel - French physician who was instrumental in the development of a more humane psychological approach to the custody and care of psychiatric patients, referred to today as moral therapy)
Medical model: The concept that diseases, in this case psychological disorders, have physical causes that can be diagnosed, treated, and, in most cases, cured often through treatment in a hospital.
Mental illness (psychopathology)

9. Ancient Treatments of psychological disorders include trephination, exorcism, being caged like animals, being beaten, burned, castrated, mutilated, or transfused with animal’s blood. Trephination (boring holes in the skull to remove evil forces

10. The Biopsychosocial Approach
Interaction of nature and nurture
Influence of culture on disorders

11. Classifying Psychological Disorders
Diagnostic and Statistical Manual of Mental Disorders (DSM)
DSM-5: The American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition; a widely used system for classifying psychological disorders.
Diagnostic labels – describes a disorder and predicts its future course
Criticisms of the DSM – “casting too wide of a net”
The most recent edition describes 400 psychological disorders compared to 60 in the 1950s.

12. Labeling Psychological Disorders
Rosenhan’s study
Power of labels
Preconception can stigmatize
Stereotypes of the mentally ill
Insanity

15. Anxiety

16. Anxiety Disorders
Anxiety disorder: Psychological disorders characterized by distressing, persistent anxiety or maladaptive behaviors that reduce anxiety.
Generalized anxiety disorder: An anxiety disorder in which a person is continually tense, apprehensive, and in a state of autonomic nervous system arousal.
2/3 women
Continual worry, jittery, agitated and sleep deprived
Free floating anxiety

17. According to the DSM… Generalized Anxiety Disorder (GAD)
Excessive anxiety and worry occurring more days than not for at least 6 months, about a number of events
The person finds it difficult to control the worry
The anxiety and worry are associated with 3 or more of the following symptoms
Restlessness or feeling keyed up or on edge
Being easily fatigued
Difficulty concentrating or mind going blank
Irritability
Muscle tension
Sleep Disturbance
D. The focus of the anxiety and worry is not confined to features of another disorder and do not occur exclusively during PTSD
E. There is clinically significant distress or impairment in functioning
F. Not due to a GMC or substance

18. Panic disorder: An anxiety disorder marked by unpredictable minutes-long episodes of intense dread in which a person experiences terror and accompanying chest pain, choking, or other frightening sensations. Often followed by worry over a possible next attack.
Panic attacks
News Anchor Panic Attack Video

19. Panic Disorder
Anti-depressant drugs that regulate norepinephrine successful in treating panic
When Locus ceruleus stimulated in monkeys  panic like behavior
Locus ceruleus rich in norepinephrine carrying neurons
Hypothesis: Norepinephrine dysregulation may well be implicated in Panic Disorder

20. Phobias: An anxiety disorder marked by a persistent, irrational fear and avoidance of a specific object, activity, or situation.
Specific phobia
Animal type
Natural environment type
Blood-Injection-Injury type
Situational type
Other type

21. Specific Phobia – what makes it a phobia?
A. Marked, persistent fear that is excessive or unreasonable, cued by the presence or anticipation of a specific object or situation B. Exposure to the phobic stimulus almost always provokes an immediate anxiety response C. The person recognizes that the fear is excessive or unreasonable D. The phobic stimulus is avoided or endured with intense anxiety or distress E. There is significant distress or an impairment in functioning due to the phobia F. The phobia is not better accounted for by another mental disorder

22. Kinds of Phobias Agoraphobia Phobia of open places. Acrophobia
Phobia of heights.
Claustrophobia
Phobia of closed spaces.
Hemophobia
Phobia of blood.

23. Other Phobias Acrophobia: Heights Aquaphobia: Water
Gephyrophobia: Bridges Ophidiophobia: Snakes
Aerophobia: Flying Arachnophobia: Spiders
Herpetophobia: Reptiles Ornithophobia: Birds
Agoraphobia: Open spaces Astraphobia: Lightning
Mikrophobia: Germs Phonophobia: Speaking aloud
Ailurophobia: Cats Brontophobia: Thunder
Murophobia: Mice Pyrophobia: Fire
Amaxophobia: Vehicles,
driving Claustrophobia: Closed spaces
Numerophobia: Numbers Thanatophobia: Death
Anthophobia: Flowers Cynophobia: Dogs

24. Social Anxiety Disorder: Intense fear of social situations, leading to avoidance of such. (Formerly called social phobia)
Marked, persistent fear of one or more social or performance situations which the person is exposed to unfamiliar people or to possible scrutiny by others. The individual fears that he or she will act in a way that will be humiliating or embarrassing.
Agoraphobia: Fear or avoidance of situations, such as crowds or wide open spaces, where one has felt loss of control and panic.

25. Obsessive-compulsive disorder: A disorder characterized by unwanted repetitive thoughts (obsessions) and/or actions (compulsions).
An obsession versus a compulsion
Checkers
Hand washers

26. Obsessive-Compulsive Disorder

27. Typical Obsessions
Doubts (e.g. Did I turn off the stove? Did I lock the door? Did I hurt someone?)
Fears that someone else has been hurt or killed
Fears that one has done something criminal
Fears that one may accidentally injure someone
Worry that one has become dirty or contaminated
Blasphemous or obscene thoughts
NOT just excessive worries about real-life problems

28. OCD Videos Scenes from the Aviator – OCD Debunking the Myths of OCD

29. Post-traumatic stress disorder: A disorder characterized by haunting memories, nightmares, social withdrawal, jumpy anxiety, numbness of feeling, and/or insomnia that lingers for four weeks or more after a traumatic experience.
PTSD
“shellshock” or “battle fatigue”
Not just due to a war situation
PTSD Video - Veterans Health Administration
Post-traumatic growth: Positive psychological changes as a result of struggling with extremely challenging circumstances and life crises.

30. The Learning Perspective
Classical and operant conditioning
Stimulus generalization
Reinforcement
Observational learning
Cognition

31. The Biological Perspective
Natural selection
Genes
Anxiety gene
Glutamate
The Brain
Anterior cingulate cortex

32. Mood Disorders Depressive Disorders

33. Bipolar I
Bipolar II
– no mania
Bipolar disorders
Mood Disorders - Emotional disturbances that interfere with normal life functioning (Axis 1)
Depressive disorders
OBJECTIVE 12| Define mood disorders, and contrast major depressive disorder and bipolar disorder.
Major Depressive Disorder
Single
Recurrent
Dysthymia

34. Major depressive disorder: A mood disorder in which a person experiences, in the absence of drugs or a another medical condition, two or more weeks with five or more symptoms, at least one of which must be either (1) depressed mood, or (2) lost of interest or pleasure.
Problems regulating appetite
Problems regulating sleep
Low energy
Low self-esteem
Difficulty concentrating and making decisions
Feelings of hopelessness
Persistent depressive disorder: Also called dysthymia. Mildly depressed mood more often than not for at least two years. Display at least 2 symptoms, where major depressive disorder patients display at least 5.

36. Bipolar Disorder: A mood disorder in which a person alternates between the hopelessness and lethargy of depression and the overexcited state of mania. (formerly called manic- depressive disorder.)
Mania (manic) A mood disorder marked by a hyperactive, wildly optimistic state.
Overtalkative, overactive, elated, little need for sleep, etc.
Disruptive Mood Dysregulation Disorder: disorder different than bipolar, diagnosis for those with emotional volatility.
Bipolar disorder and creativity

37. Understanding Depressive and Bipolar Disorders
Many behavioral and cognitive changes accompany depression
Depression is widespread
Women’s risk of major depression is nearly double men’s
Most major depressive episodes self-terminate
Stressful events related to work, marriage and close relationships often proceed depression
With each new generation, depression is striking earlier and affecting more people

38. Understanding Depressive and Bipolar Disorders

39. Biochemical influences
Understanding Depressive and Bipolar Disorders The Biological Perspective
Genetic Influences
Mood disorders run in families
Heritability
Linkage analysis – Done through twin studies
The depressed brain – Increased activity during mania, decreased during depression
Biochemical influences
Norepinephrine (more during mania, less during depression) and serotonin (trouble regulating)

40. Understanding Depressive and Bipolar Disorders The Biological Perspective

41. Mood Disorders: Psychological disorders characterized by emotional extremes.

42. Negative Thoughts and Moods Interact
Understanding Depressive and Bipolar Disorders The Social-Cognitive Perspective
Negative Thoughts and Moods Interact
Self-defeating beliefs
Learned helplessness
Rumination – overthinking, compulsive fretting
Explanatory style –blame
Stable, global, internal explanations
Cause versus indictor of depression?