Mental Health

Mental Health - Abnormal Psychology and Mental Health 0....

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Unformatted text preview: Abnormal Psychology and Mental Health 0. Read: 1. 2. 3. 4. 0. 1. 2. 3. p. 675 677 Modules 40, 41, 42, 43 p. 729 732 Modules 44, 45, 46 What is "abnormal"? This collector collects "belly button lint". And is in the Guinness Book of World Records for the largest collection. Is he "abnormal"? How do we define what is abnormal? The following definition is given by the American Psychiatric Association: 4. A behavior is only considered a psychological disorder, if and only if: 5. 1) The person experiences significant pain or distress, an inability to work or play, an increased risk of death, or a loss of freedom in some important areas of life. 5. 2) The source of the problem resides within the person, due to biological factors, learned habits, or mental processes, and is not simply a normal response to specific life events such as death of a loved one. 6. 3) The problem is not a deliberate reaction to conditions of poverty, prejudice, government policy, or other conflicts with society. What is a psychological disorder? 7. A condition in which 8. Models of Abnormality 9. The Medical Perspective 10. The perspective that mental disorders are caused: By The Psychological Perspective 11.The perspective that mental disorders are caused and maintained by: The Sociocultural Perspective 12. The perspective that: Psychological disorders are influenced by Example: Western cultures and the influence on women and girls in the development of eating disorders Diagnosis of Mental Disorders 6. Diagnosis is the process of identifying and grouping mental disorders with similar symptoms. 7. Currently, mental disorders are classified by the DSM-IV 8. The Diagnostic and Statistical Manual, Version 4 published by the American Psychiatric Association What is diagnosis used for? 13. Diagnosis of an individual is used to understand the person's symptoms 14. And to plan treatment for that person. Diagnosis as a Label 9. Labeling a person can be dangerous sometimes in that it: 10. Can limit others' perceptions of that person 11. And encourage people to see the person's behavior as disordered 12. Even when it is really normal behavior Lifetime Prevalence 15. Lifetime prevalence means: 16. How many people are diagnosed with the disorder at least once in their lifetimes? Top Three Categories in terms of Lifetime Prevalence 13. The top three categories are (in order of prevalence): ADHD 17. Read about Attention Deficit Hyperactivity Disorder in the boxes on p. 686-687. Anxiety Disorders 14. Anxiety: 15. Fear responses that are often out of proportion to any real dangers 16. Feelings of anxiety: 17. Nervous, jittery, pounding heart, trembling, cold, sweaty, dry mouth, dizzy, light-headed, fatigued, short of breath, upset stomach, diarrhea. Phobic Disorder 18. An anxiety disorder characterized by 19. Simple phobias can be about spiders, heights, snakes, etc. Social Phobia 20. An intense fear of situations that invite public scrutiny 21. Much like the social anxiety measured on the Self-Consciousness Scale Treatment: Systematic Desensitization 22. The person first draws up a list of events that could be considered frightening, and then sorts them from least to most frightening. 23.Your text gives an example on p. 742 for fear of flying in an airplane. 0. 1. 2. 3. 4. Some of the statements You see a newspaper ad for discount airfares. You visit a travel agent to make plane reservations You check in, and the agent asks if you want a window or aisle seat You're in line, with ticket in hand, ready to board. You feel the plane begin to roll down the runway. Imaginal vs. In Vivo Exposure 18. Relaxation training is given. 19. The person imagines him or herself in the situations and tries to stay relaxed. The person works through the list 20. When the person is able to stay relaxed in this imaginal exposure 21. The person may go onto in vivo exposure 22. Going through the situations in real life 23. The text talks about the use of virtual reality in helping with these fears Generalized Anxiety Disorder 24. A disorder characterized by: 25. A constant state of anxiety 26. Symptoms: being uptight, jumpy, stomach indigestion, worrying, difficulty making decisions, sensitive to criticism. Example: Generalized Anxiety Disorder 24. A 31 year old mechanic consulted a therapist because of dizziness and difficulty in falling asleep. 25. He was visibly distressed during his clinical interview, gulping, sweating, and fidgeting in his chair. 26. He repeatedly asked for water during the interview to help with his dry mouth. 27. During the interview he described how he nearly always felt tense and reported that if anything could go wrong it would. 28. He was apprehensive of possible disasters and had trouble keeping a job. 29. He indicated that he got angry too easily and little things upset him too much. He had trouble coping unless everything went just right. 30. His physical and mental concerns indicated much anxiety and nervousness. Panic Disorder 27. A disorder characterized by: Symptoms of a Panic Attack (4 or more of these symptoms) 5. Rapid heartbeat 6. Dizziness or faintness 7. Trembling or shaking 8. Fear of losing control 9. Shortness of breath 10. Hot flashes or chills 11. Excessive sweating 12. Numbness or tingling sensations 13. Everything feeling unreal 14. Nausea or abdominal distress 15. Fear of dying 16. Choking sensations 17. Chest pains 28. Panic attacks can last 15 minutes or more and are often followed by exhaustion. 29. Some times panic attacks occur at night and wake the person from sleep. 30. Frequent panic attacks lead people to worry about when and where they will have them. 31. This can create agoraphobia. Agoraphobia 31. The main symptom is an intense fear of public places. 32. Agoraphobia can keep the person from leaving his or her home. Example: A case of panic attacks and agoraphobia 33. A 28 year old housewife is afraid she can no longer care for her 3 young children. 34. Over the past year she has had recurrent episodes of "nervousness", lightheadedness, rapid breathing, trembling, and dizziness, during which things around her feel strange and unreal. 35. Formerly active and outgoing, she has become afraid to leave home unless accompanied by her husband or mother. 32. When unable to avoid supermarkets and department stores, she tries to get near the doorways and always checks for windows and exits. 33. Recently, she has wanted her mother to say with her when the children are at home as she worries about what would happen if she had one of her episodes and was unable to care for her children. Obsessive-Compulsive Disorder (OCD) 0. A disorder defined by: Common OCD rituals (compulsions) 34. Checking 79% 35. Washing 58% 36. Counting 21 % In the sample surveyed, out of 100 clients, these were the percentages reporting each ritual. Most clients have more than one compulsion Common OCD obsessions 37. Dirt, germs, and contamination 38. Aggressive impulses 39. Need for symmetry 40. Bodily concerns 41. Forbidden sexual desires These were themes that the clients worried and thought about constantly. 42. Sometimes performing compulsive actions relieves anxiety and may bring order and predictability to the world. 43. Clients with OCD know that their obsessions and compulsions aren't rational but can't help themselves. Drug Therapies for Anxiety Disorders 44. Sometimes drugs such as Valium and Ativan are used. 45. Now, some of the antidepressants such as Effexor are used because they can relieve both anxiety and depression, are non-addictive and can be used in the long-term. Mood Disorders: Disorders characterized by 36. Major Depression: 37. A mood disorder characterized by: 38. An average major depressive episode may last 2 to 8 months. 39. Approximately 15 20 % of people experience at least one episode in their lives. Gender differences in prevalence and age of onset 40. Women are more often diagnosed as depressed. 41. In U.S.: 42. 12 % of men and 21 % of women 43. As you can see here, more people first become depressed in early and middle adulthood than in childhood or the elderly years. Symptoms of Depression 44. Depressed mood 45. Decreased interest in pleasurable activities 46. Weight changes: may gain weight or lose weight. The more weight gained or lost, the more likely the person is depressed (given other symptoms) 47. Sleep changes: sleeping too much or going to sleep early and waking up early 48. Fatigue 46. Restlessness and agitation 47. Negative feelings about oneself 48. Difficulty concentrating and thinking 49. Thoughts of suicide A therapist will want to check this last in case the person is actively suicidal. Sometimes thoughts of suicide are more obsessive than an actual plan. Some possible Biological Causes 50. Genetic Factors: There is some evidence that genetics play a role. It can run in families. Neurotransmitters in Depression 51. Norepinephrine and Serotonin have both been implicated in depression. 52. Some anti-depressants (especially the older ones: MAOI's and tricyclics) work by increasing norepinephrine and serotonin levels in the brain. These have more side effects generally speaking. 53. Some anti-depressants (especially the newer ones like Prozac) work by increasing just serotonin in the brain. These tend to have fewer side effects (although they can still have some). 54. Even newer anti-depressants may work on norepinephrine and/or serotonin levels in various ways. 55. Generally, anti-depressants take about two weeks to work before the person's symptoms improve. 56. Depression: possibly too little norepinephrine and/or serotonin is being released. The drugs would increase levels of these. Other biological factors that can result in depressed feelings 49. PMS 50. Postpartum depression (due to hormonal and other changes following the birth of a child) 51. Thyroid deficiency (Thyroxin decrease leads to decreased ability to metabolize food and decreased energy) 52. Stress 53. Infectious diseases 54. Vitamin deficiencies 55. Neurological Disorders 56. Suffers of chronic pain of arthritis Electroconvulsive Therapy 57. ECT: Electric-shock treatments that often relieve severe depression by triggering seizures in the brain. 58. The person is first sedated. 59. Electrodes are placed on the head and enough current is passed through the head in order to produce seizures. 60. The treatment is repeated as prescribed by the doctor. 61. How ECT works to relieve depression is unknown because ECT has many effects on the brain. 62. It works very fast and may be used with suicidal patients. 63. It can lead to some amnesia surrounding the time of treatment. 64. Its use is very controversial. Some Psychological Causes of Depression 65. Cognitive Problems: 66. Some depressions may stem from cognitive factors. 67. Often, depressed persons may errors in thinking. Cognitive Errors seen in Depression Examples of these Cognitive Errors 68. All-or-Nothing Thinking: If you aren't perfect, seeing yourself as a failure 69. Example: A person who believes that they must get an "A" in a course. Anything less would be seen as a failure. Magnification and Minimization 70. Magnification: Seeing a negative quality as much more important than it is. 71. Example: Thinking you have a big nose and thinking that everyone is always noticing how big your nose is. 72. Minimization: Seeing a positive quality as much less important than it is. 73. Example: Someone says that they really like how you are kind to people and you conclude that they are only saying that to "be nice" to you. 74. This discounts people's true complements of you. Cognitive Therapy 75. Cognitive therapy is designed to change how the person thinks and reasons about situations. 76. The person learns how to spot these automatic errors and correct him or herself. Learned Helplessness 77. A learned expectation that one cannot control important life outcomes, resulting in apathy and depression. 78. Believing that nothing you can do will make a difference. 79. Believing this leads one to not try and that lowers the chances a situation will improve. Social Rejection 57. Unfortunately, depression can lead to social rejection by others. 58. They cannot seem to help the depressed person and the depressed person is not pleasant to be around. 59. This rejection can lead to increased depression. Suicide 80. Read the information on Suicide on p. 715-718 Bipolar Disorder 81. Bipolar disorder is a rarer mood disorder characterized by: Symptoms of Mania 60. Elevated or irritable mood 61. Inflated self-esteem (feels overly good about oneself) 62. Decreased need for sleep 63. Increased need to talk 64. Racing thoughts 65. Easily distracted 66. Increased activity 67. Increased involvement in pleasurable activities 82. Often, the mania feels good to the person. 83. The person may feel so good, he or she may not want to be treated. 84. But at the extreme, it can very much get out of control. Example 85. For 4 months, S. has spent most of her time lying in bed. She appears sad and deep in thought and often states: 86. I'm no good to anyone. I'm going to be dead soon. 87. She expresses many feelings of hopelessness and worthlessness and has difficulty concentrating. Suddenly, one day, her mood seems remarkably better. She is pleasant, talks more, and is somewhat cheerful. The following day however, she begins talking very fast, shows a flight of ideas, and intrudes into other people's activities. Over a couple of days, this activity increases to the point where she cannot control her actions and she attempts to break the furniture. Genetics and Treatment 88. There is a stronger genetic component with bipolar disorder than with major depression. 89.The main treatment of bipolar disorder is to prescribe lithium. 90. Lithium appears to smooth out the mood swings although how it works exactly is still unknown. Schizophrenia 91. Schizophrenic disorders are disorders: 92. Slightly less than 1% of the population is diagnosed with schizophrenia. 93. Men and Women are affected equally. 94. People are affected equally from all SES levels and from all cultures. Age of Onset 68. Schizophrenic symptoms usually begin between 18 25 for men and 26 45 for women. Symptoms 95. Incoherent thoughts: thoughts are confused and disorganized 96. Delusions: believing in things that no one else does 97. Hallucinations: perceiving things with the senses that no one else does. The most common hallucinations involve hearing sounds and voices, next most common are visual hallucinations. 98. Disturbance of affect (emotion): may not have any emotional reactions (flattened affect) 99. Or may have very inappropriate emotional reactions (like laughing at a funeral) 100. Bizarre behavior: may show bizarre motor movements, freeze in place, do odd things 101. Social Withdrawal: avoiding other people Symptoms: Positive and Negative 69. The symptoms of schizophrenia have been divided up into two sets of symptoms: 70. Positive symptoms: experiences that are unusual and are in addition to what most people experience 71. Negative symptoms: a reduced response or lack of normal response, feeling, thought 72. See chart on p. 724 for percentages of people diagnosed who have each of the typical symptoms. Positive symptoms 102. Disturbed thinking, hallucinations, delusions, movement disorders 103. Hallucinations: hearing, seeing, feeling or other sensory experience not created by outside stimulation (most often hearing) 104. Delusions: holding beliefs that no one else holds and appears to have little or no basis in reality Negative symptoms Lack of mood, lack of speech, inability to experience pleasure, apathy, poor insight and judgment, inability to pay attention As we will see, the positive and the negative symptoms respond differently to treatment and may have different causes. Example of Hallucinations and Delusions 73. A young woman was sent to the hospital because she complained she was being tortured and persecuted and that there were wires around her. 74. She heard the voices of three men, especially at night. These men talked about her in a very insulting way. 75. She also had the idea that electricity was passing through her body, that "they" were experimenting on her with television, and that someone was trying to seduce her by means of electric vibrations. Example of bizarre appearance, movements and inappropriate emotions 18. Emilio was brought to the hospital by his mother because she was afraid of him. 19. He was dressed in a ragged overcoat, slippers, and a baseball cap and wore several medals around his neck. 20. His emotions ranged from anger at his mother to a giggling attitude towards the interviewer. 21. His speech and manner have a childlike quality and he walks with an odd step and exaggerated hip movements. 22. He has begun hearing voices and to look and act more bizarrely. 23. When asked what he has been doing, he says "eating wires and lighting fires". His speech is often incoherent and marked by frequent rhymes. The Genetic Component 105. Schizophrenia does tend to run in families. Genetic Relatedness 0. As can be seen here, if one member of an identical twin pair is schizophrenic, 1. the other twin has a 48% chance of becoming schizophrenic. 2. It cannot be purely genetic otherwise the concordance rate would be much higher. Neurotransmitters 106. Too much dopamine is associated with the appearance of the positive symptoms. 107. Anti-psychotic (neuroleptic) drugs often work by lowering dopamine levels in the brain and are the most common treatments for this disorder. 108. One problem is getting the patient to keep taking his or her medication. Brain Deterioration 24. There is evidence that there are neural abnormalities and brain deterioration in the brains of those people with schizophrenia. 25. These problems are probably associated with the negative symptoms. 26. The negative symptoms do not usually respond as well to the standard drug treatments. The Diathesis-Stress Model 109. In this model the person has the potential to get the disease based on genetics, brain deterioration, viral infection, and other possible predisposing factors. 110. The person doesn't get the disease unless certain factors present in the environment trigger the disorder. 111. Stress is viewed as necessary to trigger the disorder. Somatoform Disorders 112. Soma means "body". 113. Somatoform disorders are disorders in which a person: Conversion Disorder 76. A disorder in which a person 77. Used to be called hysteria. 78. The person could lose the use of sense, be paralyzed, or numb in a part of the body. 79. Text: women in Cambodia who were tortured or saw family tortured and killed and became psychologically blind. Example 80. A 29 year old physician in the first year of his psychiatric residency was experiencing a great deal of stress from problems in his personal life and hospital work. 81. Shortly before he was going to discuss his work in an important hospitalwide conference being conducted by the chief psychiatrist (who had been highly critical of him) 82. He developed difficulty in speaking and severe pains in his chest. 83. He thought his condition was probably related to a viral infection but physical findings were negative. Hypochondriasis 114. A disorder characterized by 115. People with this often look for evidence of symptoms of impending illness. 116. They may be overly sensitive to the signals that their bodies are giving them and highly reactive to stimulation. 117. They may have been rewarded by others for this behavior in the past. Dissociative Disorders 118. A condition marked by 119. Types of Dissociative Experiences given by nonclinical persons 84. I was listening to someone talk and suddenly realized I did not hear part or all of what was said (94%). 85. Drove or rode somewhere without remembering later what happened during all of part of the trip (52%) 86. Found that I had no memory for some important event in my life (22%) 87. Found myself in a place and had no idea how I had gotten there (8%). 120. Psychogenic Amnesia A dissociative disorder involving 121. In psychogenic amnesia, the loss of memory is due to psychological causes. Example 122. S. H. a young woman of 18 was brought to the hospital in a state of confusion. Her mental clouding rapidly cleared after admission, but it was evident that her mind was completely blank for the events of the 7 hours prior to admission. 123. It was only when she was put into a state of light hypnosis that her memory was restored. 124. It was discovered that during the period covered by the amnesia she had suffered a major disappointment. 125. Her boyfriend had abandoned her at a time when she very much needed his help. Fugue State 126. A form of amnesia in which a Example 88. Anderson was better known as a paint manufacturer than as a writer in his hometown. 89. He would daydream to escape the boredom of a routine workday. 90. One day, he suddenly got up from his desk while dictating a letter to his secretary and walked out of the room. 91. He was not seen again until 4 days later, when he was found in a Cleveland drugstore. 127. Anderson was taken to the hospital where experts agreed he had succumbed to mental strain and was the victim of amnesia. 128. He reportedly told the story of the missing 4 days for the rest of his life, each time with different details. 129. He simply couldn't remember what happened during those 4 days. 130. In Fugue states, the person often forgets their experiences upon "waking up" from the fugue. 131. Some fugue states only last a few hours, some may last for years. Dissociative Identity Disorder 132. Formerly known as multiple personality disorder. 133. It is a condition in which an individual develops Symptoms of DID 134. Feeling like another person exists inside 135. Hearing voices talking 136. Having amnesia for childhood 137. Referring to oneself as we or us 138. Blank spells 92. Being told by others of unremembered events 93. Feelings of unreality 94. Strangers know the person 95. Noticing that objects are missing 96. Coming out of blank spells into strange places 97. Objects are present that cannot be accounted for 98. Different handwriting styles 99. Of those diagnosed and surveyed: 100. 88 percent reported having been victims of sexual, physical, and/or emotional child abuse. 101. The disorder is 9 times more common in women than in men. 102. Often this abuse begins occurring at a relatively young age. 103. Each personality may have its own voice, speech pattern, motor habits, memories, clothing, handwriting, allergies, brain-wave patterns, etc. Example: Sybil 104. Sybill was a college graduate who became a schoolteacher. In 1954, she bgan working on a Master's degree. 105. She came to a psychiatrist's attention because she was having blackouts and periods of amnesia that were becoming longer. 106. During therapy one day, her voice changed, her manner changed, she began to act like a little girl, and threw a temper tantrum. 107. A short time later a third personality emerged who called herself Vicki. 108. Sybil was unaware of other personalities but Vicki knew about them. 109. It was later revealed that Sybil had 16 personalities in all. 110. Some of the personalities were children, some were adults. 111. Some were even male. 112. During the therapy, it was discovered that Sybil had been abused and tortured by her schizophrenic mother from the age of 3 years. 113. Each time she encountered a situation she couldn't handle, she created a personality to deal with the stress. 114. Over the course of several years the psychiatrists worked with all 16 personalities attempting to solve their problems and integrating them into a 17th new and whole personality. Personality Disorders 139. A group of disorders characterized by a personality that is highly inflexible and maladaptive. 140. Approximately 5 10 % of population are believed to have some personality disorder. 141. Generally, people with personality disorders are difficult to treat because they are often not motivated to change. Borderline Personality Disorder 115. A type of personality characterized by instability in one's self-image, mood, and social relationships and lack of clear identity. 116. Text suggests that Marilyn Monroe may have been someone with borderline personality disorder. 117. These people tend to be clingy but impulsive and emotional. They may be bored and empty and uncertain of who they are or what they want to do. 118. More commonly diagnosed in women. 119. Some engage in self-mutilation, some attempt suicide. Antisocial Personality Disorder 142. A personality disorder involving a chronic pattern of self-centered, manipulative, and destructive behavior towards others. 143. More commonly diagnosed in men. 144. Once called sociopaths or psychopaths. 145. Generally have no conscience. Destructive behavior is often seen in childhood. 146. When intelligent, the person can be charming and cunning. Psychological Therapies 120. Where do people go for help? What orientations do therapists take? Therapies 147. Make sure you go through the pages specified on the first handout and get the basic points about each of the therapies listed. Psychoanalysis (p. 733 739) Behavioral therapies (p. 739 746) Cognitive therapies (p. 746 749) Roger's Person-Centered Therapy (p. 749 - 751) Gestalt Therapy (p. 751 - 752) Group Therapy (p. 752 754) Psychoactive Drug Therapies (p. 765 770) Electroconvulsive Therapy (p. 770 771) Psychosurgery (p. 771 - 772) Important ingredients in therapy (p. 759 761) ...
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