PSYCHOPATHOLOGY

DIAGNOSIS AND

TREATMENT STRATEGIES

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ANXIETY, SOMATOFORM, AND DISSOCIATIVE DISORDERS

Phobias

Generalized anxiety disorder

Panic disorder

Obsessive-compulsive disorder

Conversion disorder

Hypochondriasis

Somatization disorder

Pain disorder

Amnesia/fugue

Dissociative identity disorder (multiple personality disorder)

Disorder

Anxiety disorders

Somatoform disorders

Dissociative disorders

Subtypes Major Symptoms

Intense, irrational fear of objectively nondangerous situations or things, leading to disruptions of behavior.

Excessive anxiety not focused on a specific situation or object; free-floating anxiety.

Repeated attacks of intense fear involving physical symptoms such as faintness, dizziness, and nausea.

Persistent ideas or worries accompanied by ritualistic behaviors performed to neutralize the anxiety-driven thoughts.

A loss of physical ability (e.g., sight, hearing) that is related to psychological factors.

Preoccupation with or belief that one has serious illness in the absence of any physical evidence.

Wide variety of somatic complaints that occur over several years and are not the result of a known physical disorder.

Preoccupation with pain in the absence of physical reasons for the pain.

Sudden, unexpected loss of memory, which may result in relocation and the assumption of a new identity.

Appearance within same person of two or more distinct identities, each with a unique way of thinking and behaving.

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ANXIETY DISORDERS

PANIC DISORDER GENERALIZED ANXIETY DISORDER PHOBIAS OBSESSIVE-COMPULSIVE DISORDER POST-TRAUMATIC STRESS DISORDER

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PANIC DISORDER

Experience reoccurring episodes of anxiety attacks; unpredictable; some situations might become related to it.

Anxiety attack: 5 needed may last a couple of minutes to hours

heart palpitationstense muscles, especially chest muscles often misinterpreted for heart attack, choking sensation from tight neck muscles, faint or dizzy feeling, increase sweat, hot or cold flashes.

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GENERALIZED ANXIETY DISORDER

Persistent level of anxiety lasting at least one month Symptoms:Motor: Tension of muscles: shakes, tremble, unable to relax, twitch, startle easily Autonomic hyperactivity: Sweat, increased heart rate, cold hands, hot, cold flashes, light headed and dizzy Apprehension--worry constantly Vigilance and scanning: hyperattentive to things in the environment, distractible, hard to concentrate, impatient, irritable.

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PHOBIA

Irrational fear response of specific stimuli

SOCIAL PHOBIAS AGORAPHOBIA SPECIFIC PHOBIAS

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OBSESSIVE-COMPULSIVE DISORDER

Marked by overt ritualistic behavior and persistent intruding thoughts

Occurs at a frequency so high as to interfere with daily functioning

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SOMATOFORM DISORDERS

HYPOCHONDRIASIS CONVERSION HYSTERIA

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HYPOCHONDRIASIS

Preoccupation with body and illness No relief if given healthy diagnosisJust as tense--travel and search for new physicians

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CONVERSION DISORDER

Individual has dramatic physical symptoms with no organic cause. 1. Paralysis of legs/arms/ total 2. Anesthesia--lost sense of touch with parts of body 3. Analgesia--feel no pain 4. Other common experiences: nausea, lower back pain, dizziness, hysterical blindness, deafness, unexplained headaches 5. Unusually INDIFFERENT to symptoms 6 .Secondary gain for having symptoms 7. May disappear while asleep or under hypnosis 8. Craft Paralysis: symptoms selective to job--paralyzed hands of violinist or tennis player. 9. Symptoms make no common sense neurologically

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DISSOCIATIVE DISORDERS

DISSOCIATIVE AMNESIA DISSOCIATIVE FUGUE DISSOCIATIVE IDENTITY DISORDER

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DISSOCIATIVE AMNESIA

Memory for certain events from 1 hour to 3 months is lost Person is not distressed by loss of memory--intellectual and skills still there. Theorized as a loss of memory (repression) for traumatic event

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DISSOCIATIVE FUGUE

Amnesia for entire life & selfStarts a new life in a new location -called travelling amnesiac

Cause: extreme stress & need to fleeCan last for days, weeks, years.Extremely rare except on Soaps!

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DISSOCIATIVE IDENTITY DISORDER

Dominance of 2 or more distinct personalities

Generally amnesic for existence of others

Controversial Diagnosis

Diathesis Stress Model of Disorders

Fig13156

Precursors Diathesis Stress Outcome

Geneticfactors

Brain disease

Early learningexperiences

Bad familydynamics

Poor self-understanding

Stressful familydynamics

Social stresses

Vulnerability Disorder (e.g.schizophrenia)

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AFFECTIVE DISORDERS

MAJOR DEPRESSION DYSTHYMIC DISORDER BIPOLAR DISORDER CYCLOTHYMIC DISORDER SEASONAL AFFECTIVE DISORDER

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CLINICAL DEPRESSION

Emotions major disturbing problem but also problem in cognition (self-defeating thoughts) 1. Dysphoric mood for a minimum of 2 weeks plus 4 of following: Change in appetite usually decreaseChange in sleep--insomnia or hypersomniaChange in amount of psychomotor activity-slow or agitatedFatigue or loss of energy Feelings of worthlessness, self critical or inappropriate guilt Poor concentration Suicide or suicidal ideation

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BIPOLAR DISORDER MANIC-DEPRESSION

Elevated mood-elation and mania alternating with depressive thoughts

Mania: inflated self esteem: too self confident talkative w/flight of ideas increased activity, interests, social decreased need of sleep, distracted concern that will harm selves not judge consequences of actions shopping spree--self destructive buying pattern

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INCIDENCE OF DEPRESSIONFig147

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Risk

Prevalence ingeneral population

Fraternal twins

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10

Major depression

Identical twins

Bipolar disorder

Prevalence ingeneral population

Fraternal twins

Identical twins

40

30

60

50

80

70

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Creativity and Madness

WritersHans Christian AndersenWilliam Faulkner (H)F. Scott Fitzgerald (H),ErnestHemingway (H, S), Hermann Hesse (H, SA), Henrik IbsenHenry JamesWilliam JamesSamuel Clemens (MarkTwain)Joseph Conrad (SA)Charles DickensIsak Dinesen (SA)Ralph Waldo EmersonHerman MelvilleEugene O'Neill (H, SA)Mary ShelleyRobert Louis Stevenson Leo Tols toyTennessee Williams (H) MaryWollstonecraft (SA)Virginia Woolf (H, S)

PoetsWilliam BlakeRobert Burn s Lord ByronSamuel Taylor Coleridge EmilyDickinsonT.S. Eliot (H)Oliver GoldsmithGerard Manley HopkinsVictor HugoSamuel JohnsonJohn KeatsJames Russell LowellRobert Lowell (H) Edna St. Vincent Millay (H)Boris Pasternak (H)Sylvia Plath (H, S)Edgar Allan Poe (SA)Ezra Pound (H) Anne Sexton (H, S) Percy Bysshe Shelley (SA)Alfred, Lord Te nnyson,Dylan ThomasWalt Whitman

ArtistsPaul Gauguin (SA),Vincent van Gogh (H, S),Ernst Ludwig Kirchner (H, S),Edward Lear, Michelangelo,Edvard Meunch (H),Georgia O'Keeffe (H),George Romney,Dante Gabriel Rossetti(SA)

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SCHIZOPHRENIA

PARANOID CATATONIA DISORGANIZED HEBEPHRENIA SIMPLE RESIDUAL

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SCHIZOPHRENIA

Disturbed content, including delusions; and disorganization,including loose associations, neologisms, and word salad.

Hallucinations, or false perceptions; poorly focused attention.

Flat affect; or inappropriate tears, laughter, or anger.

Genetics; abnormalities in brain structure; abnormalities indopamine systems; neurodevelopmental problems.

Learned maladaptive behavior; disturbed patterns of familycommunication.

Aspect

CommonSymptomsDisorders ofthought

Disorders ofperception

Disorders ofemotion

Possible CausesBiological

Psychological

Key Features

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Fig15_5

15_05

Low

Min

Max

High

Challengingevents

C

A

Normalbehavior

Schizophrenicbehavior

D

B

Vulnerability

Threshold

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PERSONALITY DISORDERS

ANTISOCIAL AVOID ANT BORDERLINE

DEPENDENT HISTRIONIC NARCISSISTIC

OBSESSIVE-COMPULSIVE

PARANOID SCHIZOTYPAL

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Tab15_5

Fig15_5

Paranoid

Schizoid

Schizotypal

Depedent

Obsessive-compulsive

Avoidant

Histrionic

Narcissistic

Borderline

Antisocial

Type Typical Features

Suspiciousness and distrust of others, all of whom are assumed to be hostile.

Detachment from social relationship; restricted range of emotion.

Detachment from, and great discomfort in, social relationships; odd perceptions, thoughts, beliefs, and behaviors.

Helplessness; excessive need to betaken care of; submissive and clinging behavior; difficulty in making decisions.

Preoccupation with orderliness, perfection, and control.

Inhibition in social situations; feelings of inadequacy; oversensitivity to criticism.

Excessive emotionality and preoccupation with being the center of attention; emotional shallowness; overly dramatic behavior.

Exaggerated ideas of self-importance and achievements; preoccupation with fantasies of success; arrogance.

Lack of stability in interpersonal relationships, self-image, and emotion; impulsivity; angry outbursts; intense fear of abandonment; recurring suicidal gestures.

Shameless disregard for, and violation of, other people's rights.

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PSYCHO-SEXUAL DISORDERS

Fetishism ZoophiliaSadism Masochism

Exhibitionism Pedophilia

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DEVELOPMENTAL DISORDERS

Autism

Academic Skills Disorder

Attention Deficit Disorder w/hyperactivity

Senile Dementia

TREATMENT

PSYCHOANALYSISBEHAVIOR

HUMANISTICCOGNITIVE

BIOMEDICAL

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SIGMUND FREUDPSYCHOANALYSIS

ResistanceCatharsis

TransferenceInterpretation

Insight

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DEINSTITUTIONALIZATION

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APPROACHES TO PSYCHOLOGICAL TREATMENT

Driven by sexual andaggressive urges

Neutral; helps clientexplore meaning of freeassociations and othermaterial from theunconscious

Emphasizes unresolvedunconscious conflictsfrom the distant past

Psychosexual maturitythrough insight;strengthening of egofunctions

Free association; dreamanalysis, analysis oftransference

Dimension

Nature of the humanbeing

Therapist’s role

Time frame

Goals

Typical methods

ClassicalPsychoanalytic

ContemporaryPsychodynamic Phenomenological Behavioral

Driven by the need forhuman relationships

Active; developsrelationship with client asa model for otherrelationships

Understanding the past,but focusing on currentrelationships

Correction of effects offailures of earlyattachment; develop mentof satisfying intimaterelationships

Analysis of transferenceand countertransference

Has free will, choice, andcapacity for self-actualization

Facilitates client’s growth;some therapists areactive, some nondirective

Here and now; focus onimmediate experience

Expanded a wareness,fulfillment of potential;self-acceptance

Reflection-orientedinterviews designed toconvey unconditionalpositive regard, empathy,congruence; exercises topromote self-awareness

A product of sociallearning and condi tioning;behaves on the b asis ofpast experience

Teacher/trainer wh ohelps client replaceundesirable thoughts andbehaviors; active, action-oriented

Current behavior andthoughts; may not needto know original causes inorder to create change

Changes in thinking andbehaving in particularclasses of situations;better self-management

Systematicdesensitization, modeling,assertiveness and socialskills training, positiverein-forcement, aversiveconditioning, punishment,extinction, cog-nitive restructuring

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CARL ROGERSCLIENT CENTERED

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HUMANISTIC THERAPY55

BASIC HUMAN NEEDS

OTHERS' RESPONSES RESULT

SELF GUIDES

MENTAL HEALTHEFFECTS

Self-actualization

Self = oughts

Self = ideals

AnxietyShameGuilt

SadnessDisappointmentDepression

Need forself-actualization

Need forpositive regard

Unconditionalpositive regard

Conditionalpositive regard

Self-discrepancies

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ROLLO MAYEXISTENTIAL THERAPY

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ALBERT BANDURAMODELING

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BEHAVIOR AND COGNITIVE

SY STEM A TIC D ESEN SITIZA TION

M OD ELIN G

F LOOD IN G

R A TION A L EM OTIV E ELLIS

IM P LOSIV E

STR ESS IN N OCU LA TION

A V ER SION

COGN ITIV E --BECK

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BIOLOGICAL TREATMENTS FOR PSYCHOLOGICAL DISORDERS

Severe depression

Schizophrenia,severe depression,obsessive-compulsivedisorder

Anxiety disorders,depression,obsessive-compulsivedisorder, mania,schizophrenia

Method

Electroconvulsivetherapy (ECT)

Psychosurgery

Psychoactivedrugs

TypicalDisorders Treated Possible Side Effects Mechanism of Action

Temporary confusion,memory loss

Listlessness,overemotionality,epilepsy

Variable, depending ondrug used: movementdisorders, physicaldependence

Uncertain

Uncertain

Alteration ofneurotransmittersystems in the brain

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ELECTRO-CONVULSIVE SHOCK TREATMENT (ECT)

Single most effective treatment for psychotic depression

Used as treatment of last resort Actual understanding of how it works is not

complete--disrupts electrical impulses of brain Within two to four weeks many see profound mood

elevation Side Effects include memory loss (usually short term)

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PSYCHOSURGERY

PREFRONTAL LOBOTOMY Removal of brain tissue to relieve symptoms Pre-frontal lobotomy first used on gorillas and found to calm

aggression; applied to patients in mental institutions beginning in the 1950’s

Often used on schizophrenics bringing flat affect Today smaller amount of tissue can be removed from specific

areas showing malfunction--cingulotomy Can be very effective at removing tumor and other tissue

causing abnormal behaviors

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BIOMEDICAL TREATMENTS

Drug Treatment Options: Anti-Anxiety Xanax

GABA neurotransmitter Anti-Depressant drugs Prozac

Serotonin and Norepinephrine Anti-Psychotic drugs Thorazine

Dopamine

PSYCHOTHERAPY VS NONE 41

Number of

people

No improvement Outstanding

improvement

Average

untreated

person

Average

treated

person

80% ofuntreatedpersons