Psychopathology and Treatment. Definition Psychopathology Psychopathology Clinical term Clinical term A disorder of the mind that interferes with everyday.
Post on 28-Dec-2015
230 Views
Preview:
Transcript
Psychopathology Psychopathology and and
TreatmentTreatment
DefinitionDefinition Psychopathology Psychopathology
Clinical termClinical term A disorder of the mind that interferes with everyday A disorder of the mind that interferes with everyday
functioningfunctioning InsanityInsanity
Legal termLegal term Definition has changed over timeDefinition has changed over time Mental illness or defect decreased the individual’s Mental illness or defect decreased the individual’s
capacity to appreciate the criminality of their capacity to appreciate the criminality of their behavior or to conform to the lawbehavior or to conform to the law
DiagnosisDiagnosis Emil Kraeplin (1883) Emil Kraeplin (1883)
First to propose a classification system for First to propose a classification system for mental disordersmental disorders
Noticed that not all patients with mental illness Noticed that not all patients with mental illness suffered from the same disordersuffered from the same disorder
Noticed that certain symptoms tended to cluster Noticed that certain symptoms tended to cluster together as a unique syndrome or disordertogether as a unique syndrome or disorder
DiagnosisDiagnosis Categorical vs Dimensional Diagnosis?Categorical vs Dimensional Diagnosis? Categorical Categorical
Set of symptoms that vary togetherSet of symptoms that vary together Must meet minimum threshold (e.g., 4 or more Must meet minimum threshold (e.g., 4 or more
symptoms out of 9), to have the disordersymptoms out of 9), to have the disorder DimensionalDimensional
May involve a set of symptomsMay involve a set of symptoms Disorder varies in degree of severity (from non-Disorder varies in degree of severity (from non-
existent to severe)existent to severe)
DiagnosisDiagnosis Diagnostic and Statistical Manual of Mental Diagnostic and Statistical Manual of Mental
Disorders IVDisorders IV Categorical diagnostic systemCategorical diagnostic system Specifies sets of observable symptoms for each Specifies sets of observable symptoms for each
disorderdisorder Specifies criteria for having or not having the Specifies criteria for having or not having the
diagnosisdiagnosis Because symptoms of different disorders overlap, Because symptoms of different disorders overlap,
gives information for differential diagnosis gives information for differential diagnosis
DiagnosisDiagnosis
Difficulties in DiagnosisDifficulties in Diagnosis Rosenhan (1973)Rosenhan (1973)
8 participants (pseudo-patients) approached 12 8 participants (pseudo-patients) approached 12 different psychiatric hospitals different psychiatric hospitals
All reported hearing voices saying “thud,” “empty,” All reported hearing voices saying “thud,” “empty,” and “hollow”and “hollow”
Reported no history of psychiatric problemsReported no history of psychiatric problems Reported no other symptomsReported no other symptoms All other information about past history was accurateAll other information about past history was accurate Once in the hospital, stopped reporting symptom and Once in the hospital, stopped reporting symptom and
behaved normallybehaved normally
Difficulties in DiagnosisDifficulties in Diagnosis All 12 hospitals admitted the pseudo-patientsAll 12 hospitals admitted the pseudo-patients All pseudo-patients were given the diagnosis All pseudo-patients were given the diagnosis
of Schizophreniaof Schizophrenia Took between 7 and 52 days to be releasedTook between 7 and 52 days to be released All released with a diagnosis of Schizophrenia All released with a diagnosis of Schizophrenia
in Remissionin Remission None of staff, but some of the patients, None of staff, but some of the patients,
realized that the pseudo-patients were “sane”realized that the pseudo-patients were “sane”
Determining RiskDetermining Risk Risk for Self-Harm or Harm of OthersRisk for Self-Harm or Harm of Others
Mental health professionals have legal Mental health professionals have legal responsibility to breach confidentiality if they responsibility to breach confidentiality if they determine that a patient is at risk for harming determine that a patient is at risk for harming him/herself or someone elsehim/herself or someone else
E.g., Tarasoff CaseE.g., Tarasoff Case
Problem Problem determining potential for harm is determining potential for harm is difficultdifficult
Causes of Mental DisorderCauses of Mental Disorder Biological/GeneticBiological/Genetic
Brain structure or Brain structure or neuronal defectneuronal defect
Inherited Inherited predispositionpredisposition
PsychologicalPsychological Faulty defense Faulty defense
mechanismsmechanisms
Social FactorsSocial Factors Family Systems ModelFamily Systems Model Sociocultural ModelSociocultural Model
Cognitive BehavioralCognitive Behavioral Classical/operant Classical/operant
conditioningconditioning Modeling/Vicarious Modeling/Vicarious
reinforcementreinforcement
Treatment is based on the conceptualization of the disorder
Anxiety DisordersAnxiety Disorders
Anxiety DisordersAnxiety Disorders Characterized by the experience of excessive anxiety Characterized by the experience of excessive anxiety
in the absence of true danger and avoidance behaviorin the absence of true danger and avoidance behavior
Anxiety is our built-in alarm system Anxiety is our built-in alarm system developed developed to warn us of a threat and give us the energy to to warn us of a threat and give us the energy to respond to the threatrespond to the threat
Excessive, chronic anxiety without identifiable Excessive, chronic anxiety without identifiable cause and that leads to avoidance of non-cause and that leads to avoidance of non-threatening stimuli is abnormalthreatening stimuli is abnormal
Anxiety DisordersAnxiety Disorders Phobic DisordersPhobic Disorders
Social PhobiaSocial Phobia Specific PhobiasSpecific Phobias
Generalized Anxiety DisorderGeneralized Anxiety Disorder Panic DisorderPanic Disorder
With or without agoraphobiaWith or without agoraphobia Obsessive Compulsive DisorderObsessive Compulsive Disorder Post-Traumatic Stress DisorderPost-Traumatic Stress Disorder
Panic Disorder with Panic Disorder with AgoraphobiaAgoraphobia
SymptomsSymptoms Panic DisorderPanic Disorder
Attacks of terror that are sudden, overwhelming, and Attacks of terror that are sudden, overwhelming, and unexpectedunexpected
Did not follow situation that naturally elicits anxiety or Did not follow situation that naturally elicits anxiety or in which the individual was the focus of other’s in which the individual was the focus of other’s attentionattention
Involves fear of dying, of going crazy, or losing controlInvolves fear of dying, of going crazy, or losing control With AgoraphobiaWith Agoraphobia
Fear of situations where escape might be difficult or Fear of situations where escape might be difficult or embarrassing or where help may be unavailable in the embarrassing or where help may be unavailable in the event of an attackevent of an attack
Individual avoids such situations, goes only if Individual avoids such situations, goes only if accompanied, or endures with significant discomfortaccompanied, or endures with significant discomfort
CausesCauses Biological/GeneticBiological/Genetic
Locus coeruleus is the area of the brain that Locus coeruleus is the area of the brain that perceives novelty perceives novelty serves as an alarm system serves as an alarm system
Abnormalities of the locus coeruleus result in Abnormalities of the locus coeruleus result in increased arousal of the central nervous systemincreased arousal of the central nervous system
Increased arousal of CNS Increased arousal of CNS increased sensitivity increased sensitivity to internal and external cues signaling threatto internal and external cues signaling threat
CausesCauses Cognitive BehavioralCognitive Behavioral
Symptoms of anxiety and panic are similar to Symptoms of anxiety and panic are similar to symptoms associated with heart attacksymptoms associated with heart attack
Panic-prone people monitor bodily sensations for Panic-prone people monitor bodily sensations for symptoms that might signal an attacksymptoms that might signal an attack
Presence of symptoms result in life-threatening Presence of symptoms result in life-threatening cognitions (catastrophizing)cognitions (catastrophizing)
Increased focus on bodily sensations + Increased focus on bodily sensations + catastrophizing catastrophizing spiking of anxiety or panic spiking of anxiety or panic
CausesCauses
W. W. Norton
CausesCauses Agoraphobia results from negative Agoraphobia results from negative
reinforcementreinforcement Individuals are fearful of having another panic Individuals are fearful of having another panic
attackattack Going to places where escape might be difficult or Going to places where escape might be difficult or
where it would be embarrassing to have an attack where it would be embarrassing to have an attack increased anxiety increased anxiety
Panic disordered individuals avoid such placesPanic disordered individuals avoid such places Avoidance Avoidance avoidance of fear/anxiety avoidance of fear/anxiety
increased avoidanceincreased avoidance
TreatmentTreatmentPanic Disorder with Panic Disorder with
AgoraphobiaAgoraphobia
MedicationMedication Anxiolytic medications or tranquilizersAnxiolytic medications or tranquilizers
Benzodiazepines (e.g., Valium; Klonapin)Benzodiazepines (e.g., Valium; Klonapin) Used for short-term treatment of anxietyUsed for short-term treatment of anxiety Reduce anxiety and promote relaxationReduce anxiety and promote relaxation High degree of addiction potentialHigh degree of addiction potential
Selective Serotonin Reuptake Inhibitors (SSRI)Selective Serotonin Reuptake Inhibitors (SSRI) Primarily for the treatment of depressionPrimarily for the treatment of depression Appear to have anxiolytic propertiesAppear to have anxiolytic properties Can be used for long-termCan be used for long-term Though not addictive, can have unpleasant side effectsThough not addictive, can have unpleasant side effects
Behavioral TherapyBehavioral Therapy Cognitive Behavioral TherapyCognitive Behavioral Therapy
Education about biological and learning bases of Education about biological and learning bases of panicpanic
Cognitive RestructuringCognitive Restructuring Identifying anxiety-producing thoughtsIdentifying anxiety-producing thoughts Challenging thoughts with accurate informationChallenging thoughts with accurate information Substituting calming and empowering thoughts for Substituting calming and empowering thoughts for
anxiety-producing thoughtsanxiety-producing thoughts
Behavioral TherapyBehavioral Therapy Cognitive Behavioral TherapyCognitive Behavioral Therapy
Relaxation trainingRelaxation training Diaphragmatic breathingDiaphragmatic breathing Progressive muscle relaxationProgressive muscle relaxation
Systematic desensitizationSystematic desensitization Imaginal exposureImaginal exposure In vivo exposureIn vivo exposure
Behavioral TherapyBehavioral Therapy Systematic DesensitizationSystematic Desensitization
Develop fear hierarchyDevelop fear hierarchy
Expose patient to feared stimuli on hierarchyExpose patient to feared stimuli on hierarchy Start with a low-fear stimulusStart with a low-fear stimulus Continue to expose to low-fear stimulus until fear Continue to expose to low-fear stimulus until fear
extinguishesextinguishes Move to slightly more feared stimulus only after lower-Move to slightly more feared stimulus only after lower-
feared stimulus is masteredfeared stimulus is mastered
Panic DisorderPanic DisorderExerciseExercise SymptomSymptom
SpinningSpinning Dizziness, faintnessDizziness, faintness
GaggingGagging ChokingChoking
JoggingJogging Increased heart rate, increased B/p, chest Increased heart rate, increased B/p, chest tightness, sweating, flushingtightness, sweating, flushing
PushupsPushups Chest tightness, arm tightnessChest tightness, arm tightness
Holding breathHolding breath Chest tightness, depersonalization, derealization, Chest tightness, depersonalization, derealization, suffocatingsuffocating
HyperventilatingHyperventilating Dizziness, disorientation, depersonalization Dizziness, disorientation, depersonalization derealizationderealization
Inhaling COInhaling CO22 Choking, suffocating, derealization, Choking, suffocating, derealization, depersonalizationdepersonalization
Mood DisordersMood Disorders
Mood DisordersMood Disorders Mood disorders reflect extreme Mood disorders reflect extreme
emotions that affect our ability to emotions that affect our ability to function and perform everyday function and perform everyday activitiesactivities
Mood DisordersMood Disorders Depressive DisordersDepressive Disorders (AKA unipolar (AKA unipolar
depression) depression) pervasive feelings of sadness pervasive feelings of sadness Major DepressionMajor Depression DysthymiaDysthymia
Bipolar DisordersBipolar Disorders radical fluctuations in radical fluctuations in mood from sad to elated or irritablemood from sad to elated or irritable Bipolar I Bipolar I Major Depression & Mania Major Depression & Mania Bipolar II Bipolar II Major Depression & Hypomania Major Depression & Hypomania Cyclothymia Cyclothymia Dysthymia & Hypomania Dysthymia & Hypomania
Major DepressionMajor Depression
SymptomsSymptoms Depressed mood most of the day, nearly every dayDepressed mood most of the day, nearly every day Loss of interest/ pleasure in previously enjoyed Loss of interest/ pleasure in previously enjoyed
activitiesactivities
Significant weight loss or gain (> 5% of body weight)Significant weight loss or gain (> 5% of body weight) Insomnia/hypersomniaInsomnia/hypersomnia Psychomotor agitation or retardationPsychomotor agitation or retardation Fatigue or loss of energyFatigue or loss of energy Feelings of worthlessness or guiltFeelings of worthlessness or guilt Impaired thinking/concentrationImpaired thinking/concentration Recurrent thoughts of death or of suicideRecurrent thoughts of death or of suicide
CausesCauses GeneticGenetic
Twin, family, and adoption studies suggest a Twin, family, and adoption studies suggest a genetic component for depressiongenetic component for depression
Identical twins 4 X more likely to be concordant Identical twins 4 X more likely to be concordant for depression than Fraternal twinsfor depression than Fraternal twins
BiologicalBiological Low levels of norepinephrine Low levels of norepinephrine depression depression Low levels of serotonin Low levels of serotonin depression depression
CausesCauses Biological (continued)Biological (continued)
Circadian rhythms, particularly patterns of Circadian rhythms, particularly patterns of sleeping and waking, are associated with sleeping and waking, are associated with depressiondepression
Seasonal Affective Disorder Seasonal Affective Disorder As amount of daylight decreases, level of As amount of daylight decreases, level of
depression increasesdepression increases
Seasonal Affective DisorderSeasonal Affective Disorder
CausesCauses Social/EnvironmentalSocial/Environmental
More stressful events More stressful events greater likelihood of greater likelihood of developing depressiondeveloping depression
Having a close Having a close friendship friendship mitigates mitigates against the impact of against the impact of stressful life eventsstressful life events
CausesCauses Cognitive (A.T. Beck)Cognitive (A.T. Beck)
Cognitive TriadCognitive Triad Depressed people think about themselves, their Depressed people think about themselves, their
situation, and the future in a negative mannersituation, and the future in a negative manner AttributionsAttributions
Failures/misfortunes = (internal causes) personal defectsFailures/misfortunes = (internal causes) personal defects Successes = (external causes) luckSuccesses = (external causes) luck
Errors in LogicErrors in Logic Overgeneralizing based on single eventsOvergeneralizing based on single events Magnifying the seriousness of eventsMagnifying the seriousness of events Taking responsibility for bad eventsTaking responsibility for bad events
CausesCauses Learned Helplessness (Seligman)Learned Helplessness (Seligman)
People view themselves as unable to control the People view themselves as unable to control the negative events in their livesnegative events in their lives
Attribute negative events to personal defects Attribute negative events to personal defects stable and globalstable and global
People begin to feel helpless about the ability to People begin to feel helpless about the ability to make positive changesmake positive changes
Theory based on animal researchTheory based on animal research Animals placed in aversive situations that they Animals placed in aversive situations that they
could not escape could not escape passive and unresponsive passive and unresponsive
TreatmentTreatment
Depressive DisordersDepressive Disorders
MedicationMedication Early AntidepressantsEarly Antidepressants
Monoamine Oxidase Inhibitors (MAOI)Monoamine Oxidase Inhibitors (MAOI) Effective for treating depressionEffective for treating depression Highly toxicHighly toxic
Tricyclic antidepressantsTricyclic antidepressants Effective for treating depressionEffective for treating depression Cause weight gain, sedation, sweating, Cause weight gain, sedation, sweating,
constipation, heart palpitations, and dry mouthconstipation, heart palpitations, and dry mouth
MedicationMedication Modern AntidepressantsModern Antidepressants
Selective Serotonin Reuptake Inhibitors (SSRIs)Selective Serotonin Reuptake Inhibitors (SSRIs) e.g., Prozac, Lexapro, Paxile.g., Prozac, Lexapro, Paxil Increase serotonin levels by blocking reuptakeIncrease serotonin levels by blocking reuptake Some also have norepinephrine effectsSome also have norepinephrine effects Also effective for treating anxietyAlso effective for treating anxiety
Atypical AntidepressantsAtypical Antidepressants Bupropion Bupropion fewer side effects than other fewer side effects than other
antidepressants (no sexual side effects)antidepressants (no sexual side effects)
Behavioral TherapiesBehavioral Therapies Cognitive TherapyCognitive Therapy
People are depressed because of negative beliefs People are depressed because of negative beliefs about themselves, their situation and the futureabout themselves, their situation and the future
Therapy focuses on helping clientsTherapy focuses on helping clients Recognize when they are thinking negativelyRecognize when they are thinking negatively Identify the negative thoughts/beliefsIdentify the negative thoughts/beliefs Challenge the beliefs with more positive and Challenge the beliefs with more positive and
adaptive thoughts and/or behavioral adaptive thoughts and/or behavioral experimentsexperiments
Cognitive TherapyCognitive Therapy
Psychotic DisordersPsychotic Disorders
Psychotic DisordersPsychotic Disorders Psychotic disorders are characterized Psychotic disorders are characterized
by disturbances in thoughts, by disturbances in thoughts, perceptions, consciousness, and perceptions, consciousness, and emotionsemotions
These disturbances lead to impaired These disturbances lead to impaired social, personal, and/or occupational social, personal, and/or occupational functioningfunctioning
SchizophreniaSchizophrenia
SymptomsSymptoms Positive Symptoms (excesses)Positive Symptoms (excesses)
Delusions Delusions false personal beliefs based on incorrect false personal beliefs based on incorrect inferences about realityinferences about reality
Hallucinations Hallucinations false sensory perceptions that are false sensory perceptions that are experienced w/o an external sourceexperienced w/o an external source
Loosening of associations Loosening of associations shift rapidly from one topic to shift rapidly from one topic to anotheranother
Negative Symptoms (deficits)Negative Symptoms (deficits) Socially isolated and withdrawnSocially isolated and withdrawn Fail to express emotion; speech is monotonicFail to express emotion; speech is monotonic
CausesCauses
TreatmentTreatment
SchizophreniaSchizophrenia
MedicationMedication Haldol (Haloperidal)Haldol (Haloperidal)
Reduces positive but not negative symptomsReduces positive but not negative symptoms Tardive DyskinesiaTardive Dyskinesia
involuntary movements of the lips, tongue, face, legs, or involuntary movements of the lips, tongue, face, legs, or other body partother body part
Irreversible once present (some medications control these Irreversible once present (some medications control these symptoms)symptoms)
ClozapineClozapine Reduces both positive and negative symptoms; Works for Reduces both positive and negative symptoms; Works for
unremitting schizophreniaunremitting schizophrenia Side EffectsSide Effects
Seizures, heart arrythmias, weight gain, Seizures, heart arrythmias, weight gain, Fatal reduction in WBC Fatal reduction in WBC frequent blood tests required frequent blood tests required
BehavioralBehavioral Social skills trainingSocial skills training
Recognizing social cuesRecognizing social cues Regulating affectRegulating affect Recognizing signs of relapseRecognizing signs of relapse
Self-care skillsSelf-care skills
Family therapyFamily therapy Family therapy can address family environment Family therapy can address family environment
factors that increase risk of relapsefactors that increase risk of relapse Expressed EmotionExpressed Emotion
Personality DisordersPersonality Disorders
Personality DisorderPersonality Disorder When an individual relates to the world in When an individual relates to the world in
inflexible and maladaptive ways that is long-inflexible and maladaptive ways that is long-lasting and interferes with social, occupational lasting and interferes with social, occupational or other functioningor other functioning
Types of Personality DisordersTypes of Personality Disorders Cluster A Cluster A Odd or Eccentric Behavior Odd or Eccentric Behavior
ParanoidParanoid Schizoid Schizoid SchizotypalSchizotypal
Cluster B Cluster B Dramatic, emotional or erratic behavior Dramatic, emotional or erratic behavior HistrionicHistrionic NarcissisticNarcissistic BorderlineBorderline AntisocialAntisocial
Cluster C Cluster C Anxious or Fearful Behavior Anxious or Fearful Behavior AvoidantAvoidant DependentDependent Obsessive-CompulsiveObsessive-Compulsive
Borderline Borderline Personality DisorderPersonality Disorder
SymptomsSymptoms
CausesCauses GeneticsGenetics
Unclear at presentUnclear at present Often have families members with mood disordersOften have families members with mood disorders
BiologicalBiological Low Serotonin Low Serotonin depressed mood and impulsivity depressed mood and impulsivity
Social/CulturalSocial/Cultural 70-80% have history of physical or sexual abuse or 70-80% have history of physical or sexual abuse or
other traumaother trauma Caretakers who were critical or rejectingCaretakers who were critical or rejecting Caretakers who fostered dependenceCaretakers who fostered dependence
TreatmentTreatment
Borderline Personality Borderline Personality DisorderDisorder
BehavioralBehavioral Dialectical Behavior Therapy (DBT)Dialectical Behavior Therapy (DBT)
Combines elements of behavioral, cognitive, and Combines elements of behavioral, cognitive, and psychodynamic approaches psychodynamic approaches
Involves both group and individual therapy Involves both group and individual therapy sessionssessions
Begins with a discussion of what is expected of the Begins with a discussion of what is expected of the client and what can be expected of the therapistclient and what can be expected of the therapist
Dialectical Behavior TherapyDialectical Behavior Therapy Three Stages of TreatmentThree Stages of Treatment
Stage 1 Stage 1 extreme symptoms (i.e., self-injurious and extreme symptoms (i.e., self-injurious and suicidal behaviors) are replaced with more suicidal behaviors) are replaced with more effective/acceptable coping strategieseffective/acceptable coping strategies
Stage 2 Stage 2 explore and address traumatic experiences explore and address traumatic experiences
Stage 3 Stage 3 works on development of self-respect and works on development of self-respect and independent problem-solvingindependent problem-solving
learn to support and validate themselves rather than learn to support and validate themselves rather than relying on othersrelying on others
top related