Psychological Disorders: Part 2

Music:“I’ll go crazy if I don’t go crazy tonight”

http://www.youtube.com/watch?v=4q_AHAMVQ9c U2

“Paranoid”Jonas Brothers

Today’s Agenda

• 1. Schizophrenic Disorders– a) Symptoms – b) Movie: “The New State Asylums” (online)– http://www.pbs.org/wgbh/pages/frontline/shows/asylums/

– c) Theories• 2. Personality Disorders

– a) Cluster A:• E.g. Paranoid

– b) Cluster B:• E.g. Borderline, Antisocial

– c) Cluster C:• E.g. Obsessive-Compulsive, Avoidant

• 3. Quiz Questions

• 4. Movie: Home Videos and Schizophrenia (6 min.)

1. Schizophrenic Disorders

Schizophrenia “split mind”

Different from Dissociative Identity Disorder Thought Disorder

1. a) Symptoms: 1. Disturbed Thought Content

Delusions: False beliefs out of touch with realityPersecutory/ Grandiose

Expression is bizarre (e.g. loose associations/ poverty of speech) 2. Hallucinations and Disturbed Behaviour

E.g. hearing voices/ speaking to imaginary peopleAgitation or catatonic stupor

3. Disturbed Emotions E.g. laughing inappropriately/ blunted, flat affect

4. Deterioration in Functioning• E.g. Neglect of personal hygiene, social withdrawal

1. b) Prisons: The New State Asylums

• Frontline Show Available Online– Note: 2 multiple choice questions extracted from segment shown

in class will be on the final)

• http://www.pbs.org/wgbh/pages/frontline/shows/asylums/

1. c) Theories of Schizophrenia

• Genetic Contribution: (p. 635)

1. c) Theories of Schizophrenia

• Genetic Contribution: (p. 636)• But what is inherited?• Excess dopamine:• Evidence:

• Drugs that increase dopamine produce symptoms similar to schizophrenia

• Anti-psychotic drugs that decrease dopamine activity lessen schizophrenic symptoms

• Epigenetics:• Study of chemical changes to a gene that influence its

expression• (without altering DNA sequence)

• 1/200 genes of psychotic patients show epigenetic differences• For genes involved in neurotransmission & brain development

• CAMH research

• 14.19, p. 636

Integrated Model of Schizophrenia (p. 647)

2. Personality Disorders

• DSM-IV Definition: – Inflexible, enduring patterns of behavior that create

impairment in functioning (especially conflict with others) and/or subjective distress

• May involve up to 15% of population

– Cluster A: Odd-Eccentric • Distrustful, socially aloof, unable to connect with others• schizoid, schizotypal, paranoid

– Cluster B: Dramatic/Impulsive • Self-centered, (overdramatic), low impulse control• histrionic, narcissistic, anti-social, borderline

– Cluster C: Anxious/Fearful• Maladaptive efforts to control anxiety • dependent, obsessive-compulsive, avoidant

2. Personality Disorders:

• A) Cluster A: Paranoid: (4%)– Suspects (without sufficient basis) that others are exploiting, harming, or

deceiving him or her • Tends to be angry or hostile

– Is preoccupied with unjustified doubts about the loyalty or trustworthiness of friends or associates

– Persistently bears grudges, i.e. is unforgiving of insults or slights– Perceives attacks on his or her character that are not apparent to others

and is quick to react angrily– Has recurrent suspicions, without justification, regarding the fidelity of

spouse or partner– Tends to feel misunderstood, mistreated, or victimized – Avoids confiding in others for fear of betrayal

• Lacks close friendships and relationships

2. Personality disorders (cont’d)

• 2. b) Cluster B: Borderline: (2%)– 20% of psychiatric patients/ more likely to seek help– Frantic efforts to avoid real or imagined abandonment

• Inability to be alone– A pattern of unstable and intense interpersonal relationships – Emotions spiral out of control, leading to extremes of anxiety,

sadness, rage– Recurrent suicidal behavior, gestures or threats or self-

mutilating behaviour– Inappropriate, intense anger – Identity disturbance, unstable self-image or sense of self

• Chronic feelings of emptiness– Impulsivity in at least 2 areas (e.g. spending, sex, substance

abuse, reckless driving, binge eating)

2. Personality Disorders (cont’d)

• Antisocial: (3%)– Antisocial behaviors; violate the rights of others without shame or

regret• i.e. Takes advantage of others; is out for number one• Higher incidence rate in forensic settings & substance abuse

programs– Superficial charm but deceitful, using lies to con others– Consistently irresponsible– Irritable and aggressive, as indicated by repeated physical fights or

assaults– Lack of remorse– Onset before age 15– Most promising cause:

• Biological predisposition (limbic and frontal lobe abnormalities) Combined with neglect and abuse

2. Personality Disorders (cont’d)

• 2. c) Cluster C: Obsessive-compulsive: (8%)– Preoccupied with rules, details, organization, to the point

where the major point of the activity is lost – Perfectionism that interferes with task completion– Excessively devoted to work and productivity to the exclusion

of friendships or leisure activities– Show rigidity and stubbornness– Reluctant to delegate tasks or to work with others unless they

submit exactly to his way of doing things

2. c) Cluster C: (cont’d)

• Avoidant Personality Disorder– Avoids occupational activities that involve significant

interpersonal contact, because of fears of criticism, disapproval, or rejection

– Is unwilling to get involved with people unless certain of being liked

– Views the self as socially inept, inadequate, or inferior to others– Is preoccupied with being criticized or rejected in social

situations• Fear of being shamed or ridiculed

3. Review Quiz• For each case presented below, select a possible diagnosis according to the

following choices:

– A) Social anxiety D) Hypochondriasis– B) Obsessive Compulsive Disorder E) Somatoform Disorder– C) Generalized anxiety disorder F) Agoraphobia

• Wesley has gone in for a psychiatric assessment. He tells the clinician the he has been feeling apprehensive and edgy for the last month, but so far his anxiety hasn’t interfered with his job or home life.

• Doris feels terrified every time she leaves her house, and avoids doing so whenever possible.

• Kate constantly thinks about jumping in front of an oncoming car when she is walking. The only way she seems to be able to stop these self-destructive thoughts is to say Mother Goose nursery rhymes over and over to herself.

• Laura takes over 40 different vitamins and herbal remedies each day to keep herself in top physical health. Recently she had some severe dizziness, but her family doctor assured her that is was just a minor ear infection that would clear up in a few days. Laura is concerned because she is sure the ear infection is the sign of something much more serious, such as a brain tumor, and she has made appointments with three different specialists to have more testing done.

3. Review Quiz (cont’d)• For each case, select the most appropriate personality style:

– A) Avoidant B) Borderline – C) Paranoid D) Obsessive Compulsive – E) Antisocial

• Sophia has always been preoccupied with schedules, lists, and trivial details. She plans everything sown to the last detail and becomes very upset if things don’t work out the way she has planned.

• In the past 9 months Andrew has been fired by three different employers. He was unreliable and often missed work, and each employer finally let him go when they found he had been stealing money and materials. Andrew feels no remorse over his actions, but he has managed to convince each of his former employers that he is sorry for his actions, and none plan to press any charges.

• Ellen is has been feeling both depressed and anxious. She would like to be in a relationship but feels that it is out of her reach. She becomes unbearably anxious in new social situations and does not see how she will ever be able to approach or speak coherently to someone of the opposite sex.

• Roy alternates between periods in which he remains motionless and seems oblivious to his environment, and periods of hyperactivity and frenzied excitement. He seems to be responding to voices in his head.

4. Movie

• “Home Videos and Schizophrenia”– Can we learn to predict who will develop schizophrenia? In this

video, students see how psychologists are using low-tech procedures like home videos, and high-tech procedures like hormonal measure and brain scans to better understand who might develop this very serious mental health disorder.

– (6 min.)