Mental illness is an equal opportunity threat to success happiness, and contentment in life and can be found among all people of the world irrespective of age, race, gender, religion, ancestry, culture, region, social class.

You cannot infer personal weakness, bad breeding, a lack of character, or problematic parenting from mental illness. Both genetics and environment are apparent contributing causes for most types of mental disorders.

Slide prepared by Dr. Gordon Vessels 2005

Mental health can be described as functioning that results in productive activities, fulfilling relationships, the absence of serious emotional distress and reality distortion, and the resilience to adapt and cope with adversity and change.

Mental illness refers to any and all diagnosable mental disorders that (a) are characterized by abnormal thinking, feeling, or behavior and (b) limit or prevent success, comfort, or happiness in one’s personal, social, or professional lives.

Mental health can be described as functioning that results in productive activities, fulfilling relationships, the absence of serious emotional distress and reality distortion, and the resilience to adapt and cope with adversity and change.

Mental illness refers to any and all diagnosable mental disorders that (a) are characterized by abnormal thinking, feeling, or behavior and (b) limit or prevent success, comfort, or happiness in one’s personal, social, or professional lives.

Slide prepared by Dr. Gordon Vessels 2005

Three criteria• Deviant• Maladaptive • Causing

personal distress

A continuum from normal to abnormal

What Is Abnormality in

Mental Health ???

Slide prepared by Dr. Gordon Vessels 2005

There is no distinct or specific boundary between normality and abnormality. Behavior, thinking, and emotions are normal or

abnormal by degree based on the extent to which actions, thoughts, and feelings are deviant, personally distressing, dysfunctional or

maladaptive, and potentially dangerous to self or others.

NO

RM

AL

AB

NO

RM

AL

Deviance

Distress/Discomfort

Dysfunctional Behavior

The 3 most important defining aspects of abnormality.

Three defining aspects of abnormality on a continuum.

Similar slide retrieved at http://bama.ua.edu/~phill094/Ch%2014%20Monday%20Nov29.ppt#3 No author. This slide arranged by Gordon Vessels, 2005.

“Ds” Reduced:

The 4 ‘D’s– Discomfort/

Distress– Deviance– Dysfunction/

Disability/Maladaptation

– Danger

Abnormality Defined

Slide prepared by Dr. Gordon Vessels 2005

6

“D” Elements of Abnormality

– Distress (emotional suffering)– Discomfort (social situations)– Deviancy I (statistically rare)– Deviancy II (in violation of

societal standards or norms)– Dysfunction (maladaptation to

environmental conditions)– Danger (to self and/or others

due to irrational, unexpected, and unpredictable responses

Slide prepared by Dr. Gordon Vessels 2005

Time Period Concepts of Mental Illness

Primitive times Evil spirits needed to be driven out

Ancient civilizations (Greek and Roman)

It was thought to be a natural phenomenon - a relatively scientific and humanistic approach

Middle Ages (500-1300 in Italy and 1500 in Northern Europe)

Supernatural attributions including demon possession, witchcraft, sorcery, and astrology such as the movements of the moon.

Renaissance (began in the 14th century in Italy, and in the 16th century in northern Europe)

A decline in the belief in demonic possession; mental problems were irreversible; scientific inquiry and humanism make progress.

Eighteenth Century Reform - chains removed; need for medical care recognized; the first mentally ill patient was treated rather than abused in a hospital.

Nineteenth Century Research began and legislation concerning mental health was enacted; long-term custodial care hospitals were created.

Twentieth Century The start of the mental health movement; state hospitals were built; community health care centers established; holistic concept of care and short term care introduced; goal was to return patients to society, so human service programs were established; focus on prevention.

Source: an unnamed nursing student, A history of mental health. retrieved at http://www.shef.ac.uk/~nmhuk/mhnurs/online/mhhist01.htmlSlide. prepared by Dr. Gordon Vessels 2005

Reform movement

Era Setting Focus of Reform

Moral Treatment

18001850

AsylumMore humane; restorative

treatment goal

Mental Hygiene

18901920

Mental hospital or

clinic

More prevention; scientific orientation

Community Mental Health

19551970

Community mental health

center

De-institutionalization; social integration of

mentally ill

Community Support

1975-present

Community support

Mental illness as a social welfare problem (e.g., housing, employment)

Historical reform movements in mental health treatment in the US

Source: Author not identified (2005). Social Policy and Mental Health, a PPT slide show prepared at the School of Social Welfare at UC Berkeley http://socialwelfare.berkeley.edu/academic/syllabi/summer03/10.mental_illness.sum03.ppt#7 Slide prepared by Dr. Gordon Vessels 2005

Hippocrates(460 – 370 B.C.)

• Looked inside and outside the body for the causes of mental disorders.

• Identified four humors – blood, phlegm, yellow bile, black bile – a balance kept the body in good shape while imbalances caused mental disorders (e.g. excess black bile caused melancholia).

• Had a typology of personality/ character types that was aligned with these substances – sanguine, choleric, melancholic, phlegmatic.

• Introduced the terms: melancholia, mania, paranoia, and hysteria.

• Used phleboctomy, purgatives, diuretics, and hypnotics.“Statue” by Bankster Kovacs; http://banxter.com

Copied here with the artist’s written permission Source: Fisar, Z. (2003). Introduction, Development of Psychiatry. Retrieved from http://www.lf1.cuni.cz/zfisar/psychiatry/Introduction.ppt#7 Slide created by Gordon Vessels, 2005

• Hippocrates (450 B.C.): one of the first to consider that psychopathology could be a disease related to body fluids or humors

• Galen (150 A.D.): extended Hippocrates work hundreds of years later.– Humoral Theory = imbalance in 4 humors, e.g.,

too much black bile was thought to cause depression, referred to as melancholia.

• The Galenic-Hippocratic Tradition– Anticipated current views linking abnormality

with brain chemical imbalances, and provided a vocabulary used by physicians for centuries

The Biological Tradition (Disease Model)

Slide prepared by Dr. Gordon Vessels 2005

Abnormality or deviancy was sadly interpreted as a battle between good and evil

– After the fall of the Roman Empire, abnormal behavior, thinking, and emotion were thought to be caused by demons, witchcraft, and sorcery.

– Treatments included exorcism, torture, burnings, beatings, and crude surgeries.

Astrological explanations also offered.

– Lunacy caused by movements of the moon (luna meaning moon)

– This is not part of current scientific thinking, but even today many people believe in astrology.

Abnormality or deviancy was sadly interpreted as a battle between good and evil

– After the fall of the Roman Empire, abnormal behavior, thinking, and emotion were thought to be caused by demons, witchcraft, and sorcery.

– Treatments included exorcism, torture, burnings, beatings, and crude surgeries.

Astrological explanations also offered.

– Lunacy caused by movements of the moon (luna meaning moon)

– This is not part of current scientific thinking, but even today many people believe in astrology.

Middle Ages & BeyondMiddle Ages & Beyond

Painting entitled “When I meet God” by Bankster Kovacs 2004; http://banxter.com Copied here from his website with his written

permission./

Slide prepared by Dr. Gordon Vessels 2005 ©

Renaissance (1300 to 1699)The belief that mental illness was caused by evil spirits carried

into the Renaissance. Paracelsus (1493-1541) did not believe this, but he was unable to change the status quo. The mentally ill were put in prisons and prison-like asylums. Asylums were introduced

in the sixteenth century. The word “care” at this time meant removal from society. Lunatics were described as dangerous,

defective and incompetent. Their condition was considered irreversible. In 1403 the Bethlem Royal Hospital in London

began accepting lunatics. It was infamous for the brutal treatment of patients. Doctors allowed visitors to view lunatics in zoo-like cages. It wasn’t until 1700 that the

insane were called “patients.” It was not until the last half of the 18th century that this ended.

Background painting titled “I am the Doorway” by Steve Saugulis aka t-gar Check out this artist’s work at http://www.goolis-art.com Used here with written permission

Source: an unnamed nursing student who wrote, A history of mental health. retrieved at http://www.shef.ac.uk/~nmhuk/mhnurs/online/mhhist01.html Slide. prepared by Dr. Gordon Vessels 2005

The Eighteenth Century

The Eighteenth Century

During 1733-1815, Franz Mesmer pioneered a therapeutic approach to behavior. He suggested that the mentally ill could be cured by holding rods filled with iron filings in water. He thought that this gave people balance in the universe. This technique proved to be wrong, but the term "mesmerized" is from Mesmer. Philipe Pinel (1745-1826) removed the chains from 12 patients in Bicetre Hospital in 1792 - this began a move towards more humane care of patients.

Iron rods filled with what? I’m not doing it unless I can hold it in a bucket of your

blood, you flat-faced lunatic!

Slide prepared by Dr. Gordon Vessels 2005 ©

Source: an unnamed nursing student who wrote, A history of mental health. Retrieved at http://www.shef.ac.uk/~nmhuk/mhnurs/online/mhhist01.html Background painting titled “Cannibal” by Steve Saugulis aka t-gar Used here with his written permission. Slide. prepared by Dr. Gordon Vessels 2005

Franz MesmerFranz Mesmer

• Coined terms “animal magnetism”

• Cure brought about through transmission of an invisible fluid ???

• Psychological rather than physical cause proposed

• Coined terms “animal magnetism”

• Cure brought about through transmission of an invisible fluid ???

• Psychological rather than physical cause proposed

I can’t believe she’s buying this invisible juice nonsense.

I can’t believe she’s buying this invisible juice nonsense.

Oh Franzie! You wouldn’t try to have your way with me would you big boy.

Slide prepared by Dr. Gordon Vessels 2005

Jean Martin Charcot (1825-93)

• Tried to solve hysteria puzzle

• Used hypnosis to treat “hysterical” patients

• Was Sigmund Freud’s teacher

I also won a beauty contest. OK, your

right. It was the mule category at the fair,

but that doesn’t mean I’m not real pretty.

Slide prepared by Dr. Gordon Vessels 2005

The 19th CenturyThe discovery of Syphilis (General Paresis) and its link with “madness”

– Syphilis causes psychotic symptoms in late stages (delusions, hallucinations).

– L. Pasteur found the cause – a bacterial microorganism.

– Penicillin was found to be a successful treatment in 1870.

– This link reinforced the view that mental illness should be treated like a physical illness.

– Today the pendulum has swung too far in the direction of seeing mental illness only as a physical illness. This view is held by physicians and not most psychologists. Psychologists acknowledge contributing physical causes but continue to emphasize the role of the environment.

Slide prepared by Dr. Gordon Vessels 2005

Last half of the 19th century Psychiatric Disorders & Mental Retardation

Early Distinctions

A child with mental retardation

was called an“Imbecile”

A child with Psychiatric Disorder

was called a“Lunatic”

A child with normalcognition but

disturbed behavior“Morally Insane”

Slide prepared by Dr. Gordon Vessels 2005

Fascism and the World War II EraFascism and the

World War II Era• 1933 - law about

prevention of hereditable illnesses; 400,000 persons sterilized

• 1939 – euthanasia permitted; T4 action;

10,000 children murdered

• 1939-1945 – 180,000 psychiatric patients murdered in Germany

• 1933 - law about prevention of hereditable illnesses; 400,000 persons sterilized

• 1939 – euthanasia permitted; T4 action;

10,000 children murdered

• 1939-1945 – 180,000 psychiatric patients murdered in Germany

Art entitled “Monster” is used here with permission from Steve Saugulis aks t-gar. Check out his work at http://www.goolis-art.com

Fisar, Zdenek (2005). [email: zfisar@lf1.cuni.cz.]. Dept. of Psychiatry at Charles University in Prague (Mudr Jiri Raboch, Drsc., Head), Introduction: development of psychiatry. A PPT slide presentation retrieved from http://www.lf1.cuni.cz/zfisar/psychiatry/Introduction.ppt#14 Slide prepared by Gordon Vessels, 2005

The most popular current perspective about cause is a

Bio-psycho-social view:– Most mental disorders develop when a

biological or genetic predisposition (a diasthesis) is triggered by stressful environmental events or circumstances.

– Biological, psychological, and social risk factors all play a role in the development of mental disorders.

Slide prepared by Dr. Gordon Vessels 2005

Bio-Psycho-Social Model of Abnormal Behavior

Social Influences

Biological Influences

Psychological Influence

Psychological Influence

Trigger event is a biology film that has lots of blood

16 year old female student

Slide prepared by Dr. Gordon Vessels 2005

DISORDER

• Judy’s fainting causes disruptions in school and at home

• Friends and family rush to help her

• Principal suspends her

• Doctor says nothing is physically wrong

• Conditioned response to sight of blood: similar situations ─ even words ─ produce same reaction

• Tendency to escape and avoid situations involving blood

Behavioral Influences

• Increased fear and anxiety supporting the diagnosis of an anxiety disorder

• inherited over-reactive sinoaortic baroreflex arc

• Vasovagal syncope: rate

• and blood pressure • increase, body over-

compensates• Light headedness and

queasiness• Judy faints

Perspectives on the Causes of Mental Disorders

Psychodynamic - mental disorders originate in intrapsychic conflict traceable to early childhood experiences.

Medical/Biological - mental disorders are caused by specific abnormalities of the brain and nervous system.

Cognitive-Behavioral - mental disorders are learned dysfunctional behavior patterns caused by cognitive distortions.

Humanistic - mental disorders occur when people are blocked from fulfilling their potential for growth.

Sociocultural - mental disorders are shaped by culture, and appear only in certain cultures.

Slide prepared by Dr. Gordon Vessels 2005

Attitudes on Mental IllnessA recent survey of 650 Harris County residents shows

greater empathy and awareness of mental health issuesDo you think companies that provide health insurance to their employees should or should not be required to cover mental health treatment in the same way as treatment for other illnesses? Should Should 86% not 6%

Don’t know/no answer 8%

How concerned would you be if you discovered that a person being treated for a mental illness was living in your neighborhood?

Somewhat Notconcerned concerned33% 48%

Don’t Veryknow/no concernedAnswer 5% 14%

In your opinion, is mental illness primarily due to . . .

Brain SomethingDisorder Else63% 17%

Don’tKnow/no Characteranswer flaw 5%

Source: Houston Area Survey (2004) from the Chronicle, a local newspaper

Slide prepared by Dr. Gordon Vessels 2005

• Problems dealing with parents & teachers• Anxiety about school performance• Unhealthy peer pressure• Facing tough decisions• Developmental

adjustment problems• School phobia• Suicidal ideation• Drug or alcohol use• Worrying about sexuality• Fears about starting school• Dealing with death or divorce• Feeling depressed or overwhelmed• Considering dropping out of school

All children face some mental health problems such as the following:

/My Bleeding Doll by MistaBobby; http://mistabobby.deviantart.com Artwork used here with the artist’s writtenpermission.

Slide prepared by Dr. Gordon Vessels 2005

Major Diagnostic Categories• Disorders Usually First

Diagnosed in Infancy, Childhood, or Adolescence, e.g., ADHD

• Substance-related disorders• Sexual and Gender Identity Disorders• Schizophrenia• Mood Disorders• Anxiety Disorders• Somatoform Disorders• Dissociative Disorders• Sleep Disorders• Eating Disorders• Factitious Disorders• Adjustment Disorders• Impulse-control Disorders• Personality Disorders• Delirium, Dementia, Amnestic,

and Other Cognitive Disorders

Goals of Classification Describe a disorder Predict its future course Imply appropriate treatment Stimulate research into its cause

Classification describes and orders

clusters of symptoms

Diagnostic & Statistical Manual of Mental Disorders

DSM-IVDSM-IV

Slide prepared by Dr. Gordon Vessels 2005

Top Ten Principal Causes of Years Lived with Disability in Advanced Countries 1990

01000

2000300040005000

6000700080009000

10000

YLD

depression

alcohol

osteoart.

dementia

sch

bp

cerebr.vasc.

ocd

accidents

diabetes

Murray and Lopez (1997). Murray, C.J.L. & Lopez, A.D. (Eds) (1996). The Global Burden of Disease. Harvard University Press; Murray, C. J. L. & Lopez, A. (1996)

Global Health Statistics: A Compendium of Incidence, Prevalence and Mortality Estimates for over 2000 Conditions. Cambridge: Harvard School of Public Health.

Fisar, Zdenek (2005). [email: zfisar@lf1.cuni.cz.]. Dept. of Psychiatry at Charles University in Prague (Mudr Jiri Raboch, Drsc., Head), Introduction: development of psychiatry. A PPT slide presentation retrieved from http://www.lf1.cuni.cz/zfisar/psychiatry/Introduction.ppt#24 Slide prepared by Gordon Vessels, 2005.

Common and Uncommon PhobiasCommon and Uncommon Phobias

Afraid of it Bothers slightly Not at all afraid of it

Beingclosed in,

in a smallplace

Being alone

In a house

at night

Per

cen

tag

e o

f p

eop

le s

urv

eye

d

100

90

80

70

60

50

40

30

20

10

0Snakes Being

in high,exposedplaces

Mice Flyingon an

airplane

Spidersand

insects

Thunderand

lightning

Dogs Drivinga car

Being In a

crowdof people

Cats

Fisar, Zdenek (2005). [email: zfisar@lf1.cuni.cz.]. Dept. of Psychiatry at Charles University in Prague (Mudr Jiri Raboch, Drsc., Head), Introduction, development of psychiatry. A PPT slide presentation retrieved from http://www.lf1.cuni.cz/zfisar/psychiatry/Introduction.ppt#24 Slide prepared by Gordon Vessels, 2005.

Common Obsessions and Compulsions Among People with Obsessive-Compulsive Disorder (OCD), an Anxiety Disorder

Type of Obsession or CompulsionPercentage

Reporting Symptom

Obsessions (repetitive thoughts)Obsessions (repetitive thoughts)

Concern with dirt, germs, or toxins (e.g. Howard Hughes) 40

Something terrible happening (fire, death, illness, rape, injury 24

Symmetry, order, exactness, neatness (“neat freaks”; perfectionists) 17

Excessive hand washing, bathing, tooth brushing, or grooming 85

Compulsions (repetitive behaviors)Compulsions (repetitive behaviors)

Repeating rituals (in/out of door, avoiding cracks in sidewalk) 51

Checking doors, locks, car brake, homework, children, etc. 46

Slide prepared by Dr. Gordon Vessels 2005

Depression: Men compared to Women P

erce

nta

ge

of

po

pu

lati

on

ag

ed 1

8-84

E

xper

ien

cin

g m

ajo

r d

epre

ssio

n a

t so

me

po

int

in li

fe

20

15

10

5

0 USA Canada Puerto France West Italy Lebanon Taiwan Korea New Rico Germany Zealand USA Canada Puerto France West Italy Lebanon Taiwan Korea New Rico Germany Zealand

Around the worldwomen are more

susceptible todepression

Slide prepared by Dr. Gordon Vessels 2005

2 Kessler, R. et al. (1995) Archives of General Psychiatry; Volume 52: 1048-1060.

Agoraphobia

Co

mo

rbid

ity

(%)

Co-morbidity in Post Traumatic Stress Disorder, i.e. other disorders suffered by those with PTSD

Major Depressive

Episode

Gen.AnxietyDisorder

Panic Disorder

Social Anxiety Disorder

AlcoholAbuse

DrugAbuse/

Dependence

Kessler R. et al. (1995). Archives of General Psychiatry. 52:1048-1060.

60

50

40

30

20

10

Male

Female

Slide prepared by Dr. Gordon Vessels 2005

1 Kessler, R. et al. (2000) Journal of Clinical Psychiatry, Volume 61(Suppl 5):4-14. 2 Kessler, R. et al. (1995) Archives of General Psychiatry; Volume 52: 1048-1060.

Prevalence of Trauma and Related Probability of PTSD

Prevalence of Trauma and Related Probability of PTSD

Witness Accident Threat w/Weapon

Physical Attack

Molestation

Combat Rape

1

2Probability of Post Traumatic Stress Disorder

0

10203040506070

Witness Accident Threat w/ Weapon

Physical Attack

Molestation Combat Rape

%

Prevalence of Trauma

0

10

20

30

40

%

MaleFemale

Slide prepared by Dr. Gordon Vessels 2005

Prevalence of Mental Disorders Estimated percentage of people who have suffered mental disorders during their lives. The estimates

are based on the Epidemiological Catchment Area studies and the National Co-morbidity Study, as summarized by Regier and Burke (2000) and Dew, Bromet, and Switzer (2000).

3 6 9 12 15 18 21 24 27 30 33 36 39 42 45 48 51

Anxiety Disorders

Mood Disorders

Schizophrenia

Substance Abuse

Any Disorder

Disorder TypeProportion of Population with Mental Disorders During Lifetime

Slide prepared by Dr. Gordon Vessels 2005

Red, pink, and orange indicate lower levels of brain activation; white and blue indicate higher activation levels. Activity in the schizophrenic’s brain is low in the frontal lobes, which is at the top (Velakoulis & Pantelis, 1996). Activity in the manic-depressive’s brain is low in the left hemisphere and high in the right hemisphere. The reverse is usually true for schizophrenics. Researchers are finding consistent patterns that will aid in diagnosing mental disorders.

Positron emission tomography (PET) produces scanned images of the human brain.

Manic-Depression

Schizophrenia

Normal

Slide prepared by Dr. Gordon Vessels 2005

Risk of SchizophreniaL

ifet

ime

risk

of

dev

elo

pin

gS

chiz

op

hre

nia

fo

r re

lati

ves

of

a sc

hiz

op

hre

nic

Generalpopulation

Siblings Children of one

schizophrenic

Fraternaltwin

Childrenof two

schizophrenics

Identicaltwin

Contributing genetic cause – the hereditability Index is high

48%

46%

17%

9%

1%

17%

Sources: Lenzenweger, Mark F. and Dworkin, Robert H., Editors (1989 Origins and Development of Schizophrenia : Advances in Experimental Psychopathology; Gottesman, Irving I. and Moldin, Stephen O. (1998). Genotypes, genes, genesis, and pathogenesis in schizophrenia (first chapter in the former). Slide by Vessels 2005

Artwork entitled “Duality” is by Steve Saugulis aka t-gar is used here with the permission of the artist. Check out his artwork at http://www.goolis-art.com

The severity of symptoms varies from one person to

another, and, typically, symptoms will decline and

then reappear.

Symptoms are divided into Positive and Negative.

Symptoms of Schizophrenia

Slide prepared by Dr. Gordon Vessels 2005

Dimensions SchizophreniaDimensions Schizophrenia

Positive Symptoms vs Negative Symptoms

disorganized/deluded vs toneless/expressionless

inappropriate emotions vs silence/catatonia

Chronic vs Acute Schizophrenia

slow development/history of social inadequacyvs

rapid development/reaction to specific life stress

Slide prepared by Dr. Gordon Vessels 2005

“Positive” and “Negative” Symptoms of SchizophreniaPositive symptoms include abnormal thoughts, perceptions, language, and behavior.

• Delusions: false beliefs/thoughts with no basis in reality

• Hallucinations: disturbances of perception (hearing, seeing, or feeling things not there)

• Disorganized Thinking/Speech: jumping from topic to topic, responding to questions with unrelated answers, or speaking incoherently with loosely associated thoughts

• Disorganized Behavior: problems in performing routine daily activities

• Catatonic Behavior: lowered environmental awareness and responsiveness; rigid and/or inappropriate postures; resistance to movement or instructions.

Negative symptoms include the constricted range and intensity of emotional expression and communication, strange body language, and reduced interest in normal activities.

• Blunted (or flat) Affect: decreased emotional expressiveness; unresponsive immobile facial appearance; reduced eye contact

• Alogia: reduced speech; responses detached; dysfluent speech

• Avolition: lacking motivation, spontaneity, or initiative; sitting for lengthy periods or ceasing to participate in work or daily activities

• Anhedonia: lacking pleasure or interest in activities that were once enjoyable

• Attention Deficit: difficulty concentrating

Slide prepared by Dr. Gordon Vessels 2005

Genetics or a genetic predisposition could play a slightly more important causal role than environmental factors such as stressful experiences, poor early nutrition or illness, and a lack of expressed emotion in the family.

1 in 100 for the general population1 in 10 chance if a sibling or parent is

schizophrenic1 in 2 chance if identical twin is

schizophrenic or if both parents are schizophrenic

Genetics or a genetic predisposition could play a slightly more important causal role than environmental factors such as stressful experiences, poor early nutrition or illness, and a lack of expressed emotion in the family.

1 in 100 for the general population1 in 10 chance if a sibling or parent is

schizophrenic1 in 2 chance if identical twin is

schizophrenic or if both parents are schizophrenic

Brain Abnormalities

More dopamine receptorsor more sensitive receptors;

Less active in frontal lobe areas;

Low activity in frontal lobes;

Enlarged cerebral ventricles and/or smaller limbic area

Brain Abnormalities

More dopamine receptorsor more sensitive receptors;

Less active in frontal lobe areas;

Low activity in frontal lobes;

Enlarged cerebral ventricles and/or smaller limbic area

Reconstructing Venus by Shelley Bergen aka Nebu is used here with the written permission of the artist.

Neurodevelopmental causation, meaning multiple causes:

Slide prepared by Dr. Gordon Vessels 2005

There is no one cause to this complex and puzzling illness, but it is thought that a combination of genetics, biology (virus, bacteria, or an infection) and stressors inlife all play a role.

Except for the 50-50 odds for an identical twin of a schizophrenic or the child of two, there is currently no reliable way to predict whether a person will develop this serious mental disorder.

There is no one cause to this complex and puzzling illness, but it is thought that a combination of genetics, biology (virus, bacteria, or an infection) and stressors inlife all play a role.

Except for the 50-50 odds for an identical twin of a schizophrenic or the child of two, there is currently no reliable way to predict whether a person will develop this serious mental disorder.“Into the Depths” by Shelley Bergen aka Nebu is used here with her written permission.

Slide prepared by Dr. Gordon Vessels 2005

Aftermath by Psychosomatks (Garetha Botha) is used here with the artist’s written permission.

John Nash is now a famous Schizophrenic. His life story was made into a film, A Beautiful Mind.

Slide prepared by Dr. Gordon Vessels 2005

Subtypes of Schizophrenia

Paranoid: Delusions of grandeur or persecution and hallucinations

Disorganized: Disorganized speech (too vague, abstract , repetitive, unelaborated, impoverished in content; flat, blunted, or inappropriate emotion; loosely associated thoughts

Catatonic: Ranging from rigidly immobile to wildly hyperactive

Undifferentiated Symptoms include those above but symptoms as a whole or Residual do not fit one of the above types; residual means

previously schizophrenic with mild carryover symptoms

Nerida by MistaBobby; http://mistabobby.deviantart.com Artwork used here with the artist’s permission.Nerida by MistaBobby; http://mistabobby.deviantart.com Artwork used here with the artist’s permission.

Slide prepared by Dr. Gordon Vessels 2005

Disorganized Thinking

Disorganized Thinking

Self-Purification by Mista Bobby (Sychophant13X)

DelusionsThinking is fragmented and distorted by false beliefs –

typically about self and imagined threats to self.

DelusionsThinking is fragmented and distorted by false beliefs –

typically about self and imagined threats to self.

“This morning when I was at Hillside (hospital), I was making a movie. I was surrounded by movie stars. The security guard was Don Knotts. That Indian doctor in building 40 was Lou Costello. I’m Mary Poppins. Is this room painted blue to get me upset?”

“This morning when I was at Hillside (hospital), I was making a movie. I was surrounded by movie stars. The security guard was Don Knotts. That Indian doctor in building 40 was Lou Costello. I’m Mary Poppins. Is this room painted blue to get me upset?”

Breakdown in selectiveattention leaves the

person easily distracted.

Breakdown in selectiveattention leaves the

person easily distracted.

“Original Sin” by MistaBobby; http://mistabobby.deviantart.com Artwork used here with the artist’s written permission.

Slide prepared by Dr. Gordon Vessels 2005 ©

Antipsychotic drugs bind to the same receptor sites as dopamine thus blocking its action. For schizophrenics, a reduction

in dopamine activity can quiet agitation and psychotic symptoms.

Dopamine normally crosses the synapse between two neurons,

activating the second cell.

Slide prepared by Dr. Gordon Vessels 2005

Antipsychotic DrugPresynaptic

Axon Terminal

Postsynaptic Dendrite

Receptor Site

DopamineSynaptic Vesicle

Synaptic Gap

Mood Disorders

Slide prepared by Dr. Gordon Vessels 2005

Artwork entitled “Disgarded” by Steve Saugulis aka t-gar is used here with the artist’s permission; check out this artist’s work at

http://www.goolis-art.com

Mood Disorders

Bipolar Disorder or Manic-Depression: alternating between

depression and mania (an overexcited and

hyperactive state)

Bipolar Disorder or Manic-Depression: alternating between

depression and mania (an overexcited and

hyperactive state)

Major Depressive Disorder: experience prolonged hopelessness

and lethargy,sad or dysphoric mood, etc.

Major Depressive Disorder: experience prolonged hopelessness

and lethargy,sad or dysphoric mood, etc.

Other forms of depression: Dysthymia, a chronic depressed mood; Abnormal Bereavement;

Adjustment Disorder with Depressed Mood; Depressive

Personality Disorder; Depressive Disorders NOS

Other forms of depression: Dysthymia, a chronic depressed mood; Abnormal Bereavement;

Adjustment Disorder with Depressed Mood; Depressive

Personality Disorder; Depressive Disorders NOS

Types of DepressionSymptoms of Depression

1. Frequent or excessive crying2. Persistent sad, empty, dysphoric, or

irritable mood and anger (the latter two common for children)

3. Loss of interest in activities once enjoyed (“anhedonia)

4. Recurring thoughts of death, suicide, and self-harm; possible suicide attempts (adults and teens)

5. Diminished ability to concentrate and make decisions

6. Feelings of hopelessness, helplessness, worthlessness; guilt misattributed to self; low self-esteem

7. Poor or excessive appetite resulting in weight loss or gain

8. Insomnia or hypersomnia (constant sleep)

9. Fatigue, lethargy, loss of energy, lack of motivation, complacency

10. Psychomotor agitation or retardation; headaches and stomach aches among children

11. Chronic aches and pains Slide prepared by Dr. Gordon Vessels 2005

The neurotransmitter SEROTONIN is low when a person is

depressed. This causes body changes:

Pain Threshold Lowered: depressed people often feel more pain with no apparent cause. Back pain is very common among sufferers.

Sleep Disturbance: the day of a depressed person runs on an average of 22 hours, not 24. There are spikes in body temperature throughout the night that cause a person to wake and not get enough REM sleep.

SSRI medications increase serotonin, increase activity, lift depression, and may alter hormonal activity as well

activity.

Slide prepared by Dr. Gordon Vessels 2005

How SSRIs work to reduce the symptoms of depression and anxiety.

Slide prepared by Dr. Gordon Vessels 2005

There are at least 15 different serotonin receptors, each with a different function

Neurotransmitters are held in sacs at the end of the nerve cell. An electrical signal causes the sacs to merge with the membrane causing the neurotransmitter to be released into the synapse. Molecules moves across the gap and bind receptors, which are special proteins, on the adjacent nerve cell or neuron. When enough neurotransmitters have been absorbed, the receptors release the molecules. They are then broken or re-absorbed by the initial neuron and stored away for future use.

Prozac, Paxil, Zoloft, and other SSRIs enhance the affect of serotoninby preventing it from being absorbed (called re-uptake). Redux and other anti-obesity drugs increase serotonin.

Stressful situations can help cause depression, but environmental stressors are more important causes for some types of depression than others. The environment is least important with Bipolar Disorder, more important for Major Depression and Dysthymia, and definitive for Adjustment Disorder with Depressed Mood. But there is an intervening personality factor that determines how we respond to stressors — related to Rotter’s attribution theory of motivation.

Some people become depressed not because of their lack of control over environmental stressors but because of the way they habitually explain good and bad events to themselves. This explanatory style serves us or disserves as a mediator thereby determining if we experience helplessness and suffer depression

There are three dimensions to explanatory style: permanent versus temporary, universal versus

specific, and internal versus external. An internal attribution or explanation means one blames

themselves rather than forces out of their control. If a person’s explanation of a failure or problem is universal, she over-generalizes and gives up quickly. Self-explanations

that see situations as permanent make one more vulnerable. This is a detailed description of being pessimistic, perhaps with good reason, or optimistic.

Astral Blessings by by MistaBobby; http://mistabobby.deviantart.com Artwork used here with the artist’s permission.

Slide prepared by Dr. Gordon Vessels 2005

Data for 1933 through 1998 Youth in 15-24 Age Range

Rate

Per

10

0,0

00 P

op

ula

tion

25

20

15

10

5

01930 1940 1950 1960 1970 1980 1990 2000

Slide prepared by Dr. Gordon Vessels 2005

Personality Disorder Description (18 or older and multi-year pattern)

ParanoidSuspiciousness, guarded, tense; extreme distrust of others; perception of being under attack; hold grudges

Obsessive- compulsivePreoccupation with rules and order; inflexible; stiff; indecisive; perfectionististic tendencies; difficulty enjoying life.

HistrionicAttention-seeking; preoccupation with attractiveness; anger when attention seeking fails; highly dramatic, seductive, pretentious; over-value and devalue relationships; rapidly changing moods.

BorderlineLack of impulse control; drastic mood swings; sudden anger; intense unstable relationships; can’t stand to be alone; instability in behavior, emotion, identity, self-esteem, friendships, etc.

AvoidantOversensitivity to rejection; no confidence in initiating and maintaining social relationships; easily hurt or embarrassed; few close friends; sticks to routines to avoid new contacts.

DependentUncomfortable being alone; places others’ needs above one’s own to preserve relationships; wants others to make decisions; wants to be cared for; submissive.

AntisocialOnce called psychopathic or sociopathic; remorseless, selfish, reckless, deceitful, manipulative, lawbreaking, impulsive.

NarcissisticSelf-absorbed; expects special treatment and adulation; exaggerated opinion of self; poor perspective taking ability

Schizotypal Peculiarities of speech, perceptions, appearance, and behavior that unsettle others; emotionally detached and socially isolated.

Schizoid Not interested in relationships; indifferent to praise or criticism;restricted range of emotions (relatively flat affect).

Slide prepared by Dr. Gordon Vessels 2005 ©

This work of art entitled “The Compounded” is by Gareth Botha aks Psychosomatiks. It is used here with permission. http://www.cleanwaterart.com/

Generalized Anxiety Disorder: A tense, uneasy, and apprehensive feeling that is unexplainable and

unavoidable because the cause can’t be identified. May develop into “Panic Attacks.”

Phobic Disorders: irrational fear of a specific object or situation that is out of proportion to the real danger. People often accept and live with phobias. Fear of snakes, high places, crowds, public speaking, cats, etc. Social phobia is referred to as Social Anxiety Disorder.

Separation Anxiety Disorder: child cannot separate from Mother without suffering extreme distress.

Obsessive-Compulsive Disorder: Obsessions, or recurring and unwanted thoughts,

impulses, and mental images are usually connected with behavioral compulsions that

only temporarily relieve anxiety. If not performed, the person is left with unbearable anxiety. Obsessions are unwanted thoughts;

compulsions are behaviors the person can’t stop performing when they are known to be

irrational and sure to preclude happiness.

ANXIETY DISORDERSApproximately 20 to 30% of people experience an anxiety disorder.

Panic Attacks: recurring and unpredictable psychophysiological symptoms that appear in the absence of an emergency that bring sweating, shaking, racing heartbeat, fear of dying, and the feeling of totally losing control. Once experienced, it brings on a fear of fear because the experience is so intense. This can lead to the diagnosis of Panic Disorder.

Posttraumatic Stress Disorder (PTSD) results from experiencing or witnessing life threatening events that brought fear, horror, and helplessness. These events are then re-experienced vividly through recollections or dreams, or by reacting

physically and emotionally to cues of the event. Plagued by increased

arousal and a fear of reliving the event, the victim builds defenses that interfere with normal social

and occupational functioning.

Adjustment Disorder with Anxious Mood results from a fear producing psychosocialenvironmental stressor and Ends when the stressor is go

Slide prepared by Dr. Gordon Vessels 2005

Dementia of the Alzheimer’s Type, With Late Onset, Uncomplicated

Dementia due to Pick's Disease

Dementia due to Creutzfeld-Jacob disease

Dementia of the Alzheimer’s Type, With Early Onset, Uncomplicated

Dementia of the Alzheimer’s Type, With Early Onset, With Delirium

Dementia of the Alzheimer’s Type, With Early Onset, With Delusions

Dementia of the Alzheimer’s Type, With Early Onset, With Depressed Mood

Dementia of the Alzheimer’s Type, With Late Onset, With Delusions

Dementia of the Alzheimer’s Type, With Late Onset, With Depressed Mood

Dementia of the Alzheimer’s Type, With Late Onset, With Delirium

Hallucinogen Persisting Perception Disorder (Flashbacks)

Schizophrenia, Disorganized Type

Schizophrenia, Catatonic Type

Schizophrenia, Paranoid Type

Schizophreniform Disorder

Schizoaffective Disorder

Bipolar I Disorder Single Manic Episode

There are many other diagnoses in the DSM-IV. The chart here and on the next few slides lists many of them. Click on the links and learn more.

Slide prepared by Dr. Gordon Vessels 2005

Anxiety Disorder Due to General Medical Condition

Mood Disorder Due to General Medical Condition

Dementia Due to Head Trauma

Major Depressive Disorder Single Episode

Major Depressive Disorder Recurrent

Bipolar I Disorder Most Recent Episode Hypomanic

Bipolar I Disorder Most Recent Episode Manic

Bipolar I Disorder Most Recent Episode Depressed

Bipolar I Disorder Most Recent Episode Mixed

Bipolar II Disorder

Delusional Disorder

Shared Psychotic Disorder

Brief Psychotic Disorder

Autistic Disorder

Childhood Disintegrative Disorder

Rett's Disorder

Asperger's Disorder

There are many other diagnoses in the DSM-IV. The chart found here and on the next few slides list many of them. Click on the links and learn more.

Slide prepared by Dr. Gordon Vessels 2005

Pervasive Developmental Disorder NOS

Anxiety Disorder NOS

Panic Disorder Without Agoraphobia

Generalized Anxiety Disorder

Conversion Disorder

Dissociative Amnesia

Dissociative Fugue

Dissociative Identity Disorder

Dissociative Disorder NOS

Panic Disorder With Agoraphobia

Agoraphobia Without History of Panic Disorder

Social Phobia

Specific Phobia

Obsessive-Compulsive Disorder

Dysthymic Disorder

Somatoform Disorder

Paranoid Personality Disorder

There are many other diagnoses in the DSM-IV. The chart found here and on the next few slides list many of them. Click on the links and learn more.

Slide prepared by Dr. Gordon Vessels 2005

Cyclothymic Disorder

Schizoid Personality Disorder

Schizotypal Personality Disorder

Obsessive-Compulsive Personality Disorder

Histrionic Personality Disorder

Dependent Personality Disorder

Antisocial Personality Disorder

Narcissistic Personality Disorder

Avoidant Personality Disorder

Borderline Personality Disorder

Pedophilia

Transvestic Fetishism

Exhibitionism

Gender Identity Disorder NOS

Gender Identity Disorder in Children or Gender Identity Disorder NOS

Gender Identity Disorder in Adolescents or Adults

Anorexia Nervosa

There are many other diagnoses in the DSM-IV. The chart found here and on the next few slides list many of them. Click on the links and learn more.

Slide prepared by Dr. Gordon Vessels 2005

Tic Disorder NOS

Tourette's Disorder

Sleep Terror Disorder

Sleepwalking Disorder

Acute Stress Disorder

Adjustment Disorder With Depressed Mood

Separation Anxiety Disorder

Adjustment Disorder With Anxiety

Adjustment Disorder With Mixed Anxiety and Depressed Mood

Adjustment Disorder With Disturbance of Conduct

Adjustment Disorder With Mixed Disturbance of Emotions and Conduct

Posttraumatic Stress Disorder

Impulse-Control Disorder NOS

Kleptomania

Intermittent Explosive Disorder

Conduct Disorder

Oppositional Defiant Disorder

There are many other diagnoses in the DSM-IV. The chart found here and on the next slide list many of them. Click on the links and learn more.

Slide prepared by Dr. Gordon Vessels 2005

Disruptive Behavior Disorder NOS

Selective Mutism

Identity Problem

Reactive Attachment Disorder of Infancy or Early Childhood

Attention-Deficit/Hyperactivity Disorder Predominantly Inattentive Type

Attention-Deficit/Hyperactivity Disorder Combined Type

Attention-Deficit/Hyperactivity Disorder Predominantly hyperactive-Impulsive Type

Narcolepsy

Adult Antisocial Behavior

Child or Adolescent Antisocial Behavior

Malingering

Bereavement

Pathological Gambling

Enuresis (Not Due to a General Medical Condition)

Encopresis Without Constipation and Overflow Incontinence

Feeding Disorder of Infancy or Early Childhood

Pica

There are many other diagnoses in the DSM-IV. The chart found here and on the previous slides list many of them. Click on the links and learn more.

Slide prepared by Dr. Gordon Vessels 2005