Psy Ch 13

depression and schizophreniza

ongoing patterns of thoughts, feelings, and actions that are deviant, distressful, and dysfunctional

• means different
• however, it can vary with context, culture, and time

• attention deficit hyperactivity disorder
• a psychological disorder marked by the appearance by age 7 of one or more of 3 key symptoms: extreme inattention, hyperactivity, and impulsivity
• Is diagnosed 2-3 times more in boys
• Skeptics point to a single genetic variation: a Y chromosome

in 1800's, when it was discovered that syphilis infects the brain and distorts the mind

• (1745-1826) opposed the brutal treatments of mental pts
• insisted that madness is not demon possession but a sickness of the mind caused by severe stresses and inhumane conditions
• Helped start the reform toward mental health

The medical model and the biopsychological approach

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

a mental illness

assesses the whole set of interacting influences and assumes that disorders arise from genetic predispositions and physiological states(evolution, genes, brain structure and chemistry); inner psychological dynamics (stress, trama); and social-cultural circumstances (roles, expectations, what is considered normality and disorder)

• that the mind and body are inseparable
• Negative emotions contribute to physical illness and physical abnormalities contributes to negative emotions

a condition in Latin america which lays claim to a condition marked by severe anxiety, restlessness, and a fear of black magic

• a social anxiety about one's appearance combined with a readiness to blush and a fear of eye contact
• appears in Japan

In Malaysia, describes a sudden outburst of violent behavior (thus the phrase "run amok")

• They classify by using DSM-IV-TR, which provides diagnostic guidelines and categories that aid mental health professionals by providing a common language and shared concepts for communication and research
• *Most U.S. health insurance org's require DSM-IV-TR diagnoses before they will pay for therapy

based on assessments, interviews, and observations, many clinicians diagnose by answering questions from five levels, or axes, of the DSM-IV-TR

• The American psychiatric Ass.'s Diagnostic and Statistical Manual of Mental Disorders, 4th ed, updated as a 2000 "text revision"
• a widely used system for classifying psychological disorders
• reliability stems in part from it's reliance on structured-interview procedures
• *some critics fault the manual as casting to wide of a net

• Axis I: Is a clinical syndrome present?
• Axis II: Is a personality disorder or mental retardation present? (Clinicians may or may not select one of more)
• Axis III: Is a general medical condition, such as diabetes, hypertension, or arthritis also present?
• Axis IV: Are psychosocial or environmental problems, such as school or housing issues, also present?
• Axis V: What is the Global Assessment of this person's functioning? Clinicians assign a code from 0-100

• Any disorders first diagnosed in infancy - teenhood
• Cognitive disorder
• Mental due to medical condition
• Substance-related abuse
• Psychotic disorder
• Mood/anxiety disorder
• Somatoform disorders
• Faked disorders
• Dissociative disorders
• Eating/sleeping disorder
• Sexual or gender ID disorder
• Impulse-control

• a diagnostic manual of human strengths to accompany the DSM-IV-TR
• The Values in Action Classification of Strengths
• an expression of the positive psychology movement
• assesses 6 clusters of 24 strengths
• Mental health workers have used these categories to get their clients to consider what makes a good life

• Wisdom and knowledge - creativity; curiosity; love of learning; open-minded
• Courage - (overcoming opposition) bravery; perseverance; honesty and zest
• Humanity- love, kindness
• Justice - teamwork, fairness, leadership
• Transcendence - appreciation of beauty, hope, humor, spirituality
• Temperance - forgiveness and mercy, modesty and humility
• "Wise Choices Help Justyne Toward Temple"

• Labels can create preconceptions that bias our perceptions of the person's past and present behavior
• The insanity defense raises moral and ethical questions about how a society should treat people who have disorders and have committed crimes

• mental health professionals use labels to:
• communicate about their cases
• to comprehend the underlying causes
• to discern effective treatment programs

• psychological disorders characterized by distressing, persistent anxiety or dysfunctional behaviors that reduce anxiety
• 5 types

• Generalized anxiety disorder
• Panic disorder
• Phobias
• Obsessive-compulsive disorder
• Post-traumatic stress disorder
• *in it's own way, each harms quality of life
• "General Pat Phoned, Ordered Posts"

• an anxiety disorder in which a person is unexplainably and continually tense, apprehensive, often jittery, agitated, and sleep defrived, concentration is difficult
• can lead to high BP
• many people w this were maltreated and inhibited as children
• 2/3 are women
• by age 50, generalized anxiety is rare

• 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
• may be misperceived as heart attack or other serious physical ailment
• smokers have at least double risk

an anxiety disorder marked by a persistent, irrational fear and avoidance of a specific object, activity or situation

• is shyness taken to an extreme
• an intense fear of being scrutinized by others, avoid potentially embarrassing social situations such as speaking up, eating out, or going to parties, will sweat, tremble, or have diarrhea when doing so

fear or avoidance of situations in which escape might be difficult or help unavailable when panic strikes

an anxiety disorder characterized by unwanted repetitive thoughts (obsessions) and/or actions (compulsions)

• an anxiety disorder characterized by haunting memories, nightmares, social withdrawal, jumpy anxiety, and/or insomnia that lingers four weeks or more after a traumatic experience
• was once called "shellshock" or "battle fatigue"
• a sensitive limbic system seems to increase vulnerability (by flooding body with stress hormones again and again)
• Genes may also play a roll

• positive psychological changes as a result of struggling with extremely challenging circumstances and life crises
• include an increased appreciation for life, more meaningful relationships, increased personal strength, changed priorities, and a richer spiritual life

learning and biological

• Freud viewed anxiety disorders as a manifestation of mental energy associated with the discharge of repressed impulses
• *because, according to him, we REPRESS these feelings and impulses

views anxiety disorders as a product of fear conditioning, stimulus generalization, reinforcement of fearful behaviors, and observational learning of others' fear

• Stimulus generalization - (the car was hit when driver ran stop sign, not I twinge of unease when any car approaches from a side street)
• Reinforcement - helps maintain our phobias and compulsions after they arise, avoiding or escaping fear reduces anxiety, thus reinforcing behavior

• considers the role that fears of life-threatening animals, objects, or situations played in natural selection and evolution
• the genetic inheritance of a high level of emotional reactivity
• abnormal responses in the brain's fear circuits

• a brain region that monitors our actions and checks for errors
• seems especially likely to be hyperactive in those with OCD

can be created when fear-learning experiences traumatize the brain

• psychological disorder in which the symptoms take a somatic (bodily) form without apparent physical cause
• 2 types: conversion disorder and hypochondriasis

• a rare somatoform disorder (more common in Freud's day) in which a person experiences very specific genuine physical symptoms for which no physiological basis can be found
• Ex: unexplained paralysis, blindness, or inability to swallow

• a somatoform disorder in which a person interprets normal physical sensation as symptoms of disease
• Pt's and physicians fail to confront psychological root

• among the rare and most bewildering disorders
• disorder of consciousness in which a person appears to experience a sudden loss of memory or change in identity, often in response to an overwhelmingly stressful situation (painful memories, thoughts and feelings)

• dissociative identity disorder
• formerly called multiple personality disorder
• a rare dissociative disorder in which a person exhibits two or more distinct and alternating personalities
• each personality having it's own voice and mannerisms
• typically original personality denies any awareness of the other(s)

• skeptics question whether DJD is genuine disorder or an extension of our normal capacity for personality shifts
• find it suspicious that the disorder is so localized in time and space. Outside N.America much less prevalent
• such findings point to a cultural phenomenon - a disorder created by therapists in a particular social context

• psychological disorders characterized by emotional extremes which take two principle forms:
• 1. major depressive disorder (w it's prolonged hopelessness and lethargy)
• 2. bipolar disorder (person alternates btwn depression and mania)

an overexcited, hyperactive state

• called the "common cold" of psychological disorders
• #1 reason people seek mental health services
• leading cause of disability worldwide
• often response to past and current loss

a mood disorder in which at least 5 signs of depression (including lethargy, feelings of worthlessness, or loss of interest or pleasure) last two or more weeks and are not caused by drugs or a medical condition

• you know this one, much less common than general depression
• effects men & women equally
• especially prone to composers, artists, poets, novelists, and entertainers
• Not so much w people who rely on precision and logic, as architects, designers, and journalists

may view depression as unresolved anger toward one's parents, turned inward against self

focuses on genetic predispositions, abnormalities in brain structures and functions, and neurotransmitter imbalances

examines the influence of self-defeating beliefs, learned helplessness, negative attributions, and stressful experiences

considers the interaction of these andother

• may be due to the rise of individualism and the decline of commitment to religion and family
• *this is a correlational finding, so cause-effect relationship is not clear yet

• how some researchers are trying to tease out the genes that put people at risk for depression
• points to a chromosome neighborhood, (within a family, comparing those affected and those who aren't , over several generations)

norepinephrine and serotonin

• neurotransmitter, increases arousal and boosts mood, is scarce during depression and overabundant during mania
• *most people w history of depression have history of habitual smoking - may indicate attempt to self-medicate since nicotine can temporarily increase norepinephrine and boost mood

• neurotransmitter, scarce during depression
• *there are some genes under scrutiny for coding for proteins that control the activity of serotonin. In combination with significant stress, formed a receipe for depression

• Drugs that relieve depression tend to increase norepinephrine or serotonin supplies by blocking either their reuptake (like prozac, zoloft and paxil do with serotonin) or their chemical breakdown
• Repetitive physical exercise, such as jogging, reduces depression as it increases serotonin
• Boosting serotonin may promote recovery by stimulating hippocampus neuron growth

• who or what someone blames for their failures
• partly explains why some people get depressed and others dont

• 1. negative, stressful events -> interpreted through:
• 2. A ruminating, pessimistic explanatory style -> create:
• 3. a hopeless, depressed state -> that:
• 4. hampers the way we think and act -> This, in turn, fuels back to #1

• means "split mind" - chief example of psychotic disorder
• a cluster or group of severe disorders characterized by disorganized (fragmented and bizarre) and delusional thinking, disturbed perceptions, and inappropriate emotions and actions
• 5 subtypes or groups
• typically strikes during late adolescence, affects men very slightly more than women
• seems to occur in all cultures

a psychological disorder in which a person loses contact w reality, experiencing irrational ideas and distorted perceptions

• false beliefs, often of persecution or grandeur, that may accompany psychotic disorders
• **those with paranoid tendencies are particularly prone to delusions of persecution

jumbled ideas within sentences (schizophrenia)

• the normal ability to give undivided attention to one set of sensory stimuli while filtering out others
• *disorganized thoughts of schizophrenia may result from a breakdown of selective attention

• sensory experiences w/o sensory stimulation
• a person w schizophrenia may hallucinate seeing, feeling, tasting, or smelling things that are not there
• most often hallucinations are auditory, frequently voices making insulting remarks or giving orders

an emotionless state, happens w schizophrenia

• pts may experience hallucinations, talk in disorganized and deluded ways, and exhibit inappropriate laughter, tears, or rage
• *the presence of inappropriate behaviors

• pts have toneless voices, expressionless faces, or mute and rigid bodies
• *the absence of appropriate behaviors

• also called process schizophrenia
• when schizophrenia is a slow-developing process, so it emerges gradually, recovery is doubtful
• often exhibit the persistent and incapacitating negative symptom of social withdrawal

• also called reactive schizophrenia
• when schizophrenia develops suddenly following particular life stresses, recovery is much more likely
• they more often have the positive symptoms that are more likely to respond to drug therapy

• Paranoid
• Disorganized
• Catatonic
• Undifferentiated
• Residual
• "Please Don't Cum Until im Ready"

• preoccupation with delusions or hallucinations
• often with themes of persecution or grandiosity

Disorganized speech or behavior, or flat or inappropriate emotion

Immobility (or excessive, purposeless movement), extreme negativism, and/or parrotlike repeating of another's speech or movements

Many and varied symptoms

Withdrawal, after hallucinations and delusions have disappeared

• brain abnormalities
• abnormal brain activity
• dopamine overactivity
• maternal virus during mid pregnancy
• genetic factors

• Brain abnormalities, including enlarged, fluid-filled cerebral cavities and corresponding decreases in the cortex. (the greater the shrinkage, the more severe the thought disorder)
• Brain scans reveal abnormal activity in the frontal lobes, thalamus (filters sensory signals), and amygdala( the fear processing center)

• it may intensify the positive symptoms 
• people w schizophrenia have increased receptors for this neurotransmitter - a sixfold excess for the D4 dopamine receptor
• therefore, drugs that block dopamine receptors often lessen the symptoms

• brain scans have shown many people w schizophrenia have abnormal activity in multiple areas
• some have abnormally low activity in the frontal lobes, which are critical for reasoning, planning, and problem solving
• also display noticeable decline in brain waves that reflect synchronized neural firing in frontal lobes
• Therefore, out-of-sync neurons may disrupt integrated functioning of neural networks, and possible contribute to symptoms

• low birth weight and oxygen deprivation during delivery
• famine may also increase risk

• may be a casual factor
• But evidence suggests if a mothers blood indicated she had been exposed to the flu during the first half of pregnancy, chances of developing schizophrenia tripled. No such increase if in second half of pregnancy

a fatty substance that coats the axons of some nerve cells and lets impulses travel at high speed through neural networks

psychological disorders characterized by disruptive, inflexible, and enduring behavior patterns that impair people's social functioning

• One cluster expresses eccentric behaviors
• Another cluster expresses anxiety
• Yet another cluster exhibits dramatic or impulsive behaviors

• involves emotionless disengagment
• belongs to the cluster of personality disorders which express eccentric (odd or unusual) behaviors

• withdrawn, due to a fearful sensitivity to rejection
• among cluster of personality disorders which express anxiety

• attention-getting...
• among cluster of personality disorders which exhibit dramatic or impulsive behaviors

• self-focused and self-inflating
• among cluster of personality disorders which exhibit dramatic or impulsive behaviors

• formerly called a sociopath or psychopath 
• most troubling and heavily researched personality disorder
• a personality disorder in which the person (usually a man) exhibits a lack of conscience for wrongdoing, even toward friends and family members.
• feels and fears little
• May be aggressive and ruthless of a clever con artist

• Usually by early adulthood
• Symptoms of antisocial p.d. and phobias are among earliest to appear, at 8 - 10 yrs. 
• Symptoms of alcohol dependency, OCD, bipolar, and schizophrenia appear near 20 yrs.
• Major depression usually at 25 yrs.