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PSY100 Lecture 21 (November 28th, 2012).pdf

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Ashley W.Denton

Lecture 21 (November 28 , 2012) th Morad Moazami Psychological  Disorders  and  Treatment:     Mood  Disorders:     Bipolar  Disorder:     It  is  characterized  by  alternating  periods  of  depression  and  mania.     Manic  depression  is  now  known  as  bipolar  disorder.     It  is  characterized  by  alternating  periods  of  depression  and  mania.     What  a  manic  episode  is  is  the  exact  opposite  of  depression.  Moods  are  elevated,  you  have   grandiose  thoughts,  there's  increased  activity,  diminished  need  for  sleep  grandiose  ideas,  racing   thoughts,  and  extreme  distractibility.  It  also  brings  a  lot  of  inspiration,  and  people  with  manic   episodes  don't  want  to  take  their  medication,  because  it  feels  good.  They  tend  to  increase  in   impulsivity,  however  –  even  when  it  comes  to  sexual  promiscuity.  A  person  with  a  manic   disorder  do  things  that  they  would  usually  regret.   • There  is  excessive  involvement  in  pleasurable  but  foolish  activity.   • Hypomanic  episodes  are  less  extreme,  with  less  disruption.   • Not  everybody  may  go  through  a  complete  manic  episode,  and  they  may  be   hypomanic  episodes.     Those  in  manic  episodes  are  engaging  in  hedonic  activities  and  not  really  thinking  about  the   consequences.     Some  of  the  causes  and  factors  that  contribute  to  mood  disorder:     So  in  terms  of  cognitive  factors,  there  are  maladaptive  cognitive  factors  that  we  know  lead  to   mood  disorders.     The  cognitive  triad  says  that  those  in  mood  disorders  makes  you  feel  negatively  about  three   things:  yourself,  your  situation,  your  future.     If  you  put  an  animal  in  an  aversive  situation  where  escape  is  simply  impossible,  what  tends  to   happen  is  that  eventually  they’ll  try  but  after  a  period  of  time  they  fall  into  learned   helplessness,  when  they  stop  trying  and  stop  doing  anything,  and  they  will  assume  that  their   actions  will  stop  having  any  consequences,  so  learned  helplessness  is  even  in  depressed   patients  who  just  stop  trying  to  feel  better.     There  is  a  number  of  situational  factors  that  can  contribute  to  these  disorders.  Interpersonal   losses  like  losing  a  loved  one  can  prompt  a  depressive  episode.  We  also  know  that  social   support  and  having  people  around  you  to  be  there  with  you  and  emphasize  with  you  is  actually   a  protective  factor  against  depression.     • We  can  imagine  which  widow  is  going  to  go  through  a  depressive  episode:  if  your   loved  one  dies  and  you’re  alone;  if  your  loved  one  dies  and  you  have  people  around   you.     Biological  factors  are  also  important,  particularly  in  the  case  of  depression.    There  is  a  genetic   component,  and  what  the  genetics  tend  to  do  is  that  they  lead  to  a  monoamine  deficiency   (neurotransmitters  that  motivate  behavior/serotonin).  Some  other  biological  factors  are  like   biological  rhythms,  like  seasonal  effective  disorder,  which  tends  to  affect  people  in  Northern   latitudes,  where  these  are  seasonal  cycles,  and  when  dies  become  darker  sooner,  people  could   go  through  depressive  episodes.     • People  who  are  depressed  also  tend  to  have  these  destructive  sleep  patterns.  They   tend  to  get  more  REM  sleep  then  your  average  person.     Schizophrenia:     Schizophrenia  is  a  psychotic  disorder,  therefore,  it  leads  to  abnormal  thoughts.    It  is   characterized  by  alterations  in  perceptions,  emotions,  thoughts,  or  consciousness.     There  are  different  types  of  schizophrenia:   • Paranoid  type,   • Disorganized  type,   • Catatonic  type:  this  is  what  the  negative  types  of  schizophrenia  is  often  related  with.   • Undifferentiated  type   • Residual  type     The  name  schizophrenia  literally  translates  into  a  split  mind,  but  the  meaning  of  the  name  leads   people  to  think  that  schizophrenia    and  multi-­‐personality  disorder  are  the  same  thing,  but  they   are  not.     (Kind  of  funny  how  even  when  we  watch  videos  in  class,  we  have  to  watch  advertisement.   There's  this  really  strange  capitalist  thing  about  it.  You  even  watch  ads  now  during  your   education.)     Russell  Crowe  in  a  Beautiful  Mind  suffered  from  paranoid  schizophrenia.     The  positive  symptoms  of  schizophrenia  are  delusions.     Positive  symptoms  means  that  there  are  excesses  in  behavior  and  functioning.     • Delusions:  false  personal  beliefs  based  on  incorrect  inferences  about  reality.   o They  show  persistence  in  these  irrational  beliefs  despite  clear  evidence  to   the  contrary.   o There  are  a  number  of  delusions  that  people  can  suffer  from  like  paranoia   (thinking  that  people  are  watching  you  all  of  the  time),  delusions  of   grandeur,  delusions  of  reference,  etc.   • Hallucinations:  False  sensory  experiences  (can  involve  any  of  the  senses)  that  are   experienced  without  an  external  sources.  Believing  that  you’re  sensing  something   when  there  is  no  external  stimulus  there,  so  any  kind  of  false  sensory  experience.   o One  theory  about  these  hallucinations  is  that  people  with  schizophrenia  have   a  hard  time  distinguishing  between  the  inner  voice  we  all  have  and  external   voices.     • Loosening  of  associations:  Speech  pattern  in  which  thoughts  are  disorganized  or   meaningless.    It  is  hard  to  follow  their  train  of  thought.     • Disorganized  behavior:  Acting  in  strange  or  unusual  ways,  including  strange   movement  of  limbs,  bizarre  speech,  and  inappropriate  self-­‐care,  such  as  failing  to   bathe  or  dress  properly.   o Echolalia:  repetition  in  speech,  meaninglessly  repeating  a  phrase  over  and   over  again.     There  are  negative  symptoms  in  schizophrenia  too.     Negative  symptoms  are  deficits  in  functioning.   • Isolation,  withdrawal,   • Apathy,   • Blunted  emotion,   • Slowed,  monotonous  speech,   • Slowed  movement.     Negative  symptoms  are  also  much  more  difficult  to  treat  than  the  positive  symptoms  are.  The   drugs  used  to  treat  schizophrenia  are  usually  for  the  positive  symptoms,  while  the  negative   symptoms  are  more  persistent.       We  do  know  that  there  is  certainly  a  genetic  component  to  schizophrenia.  If  you  have  a  parent   with  schizophrenia,  your  risk  of  developing  it  is  higher.     There  is  also  evidence  that  there  may  be  some  environmental  factors  that  are  going  on.  One   thing  linked  to  schizophrenia  is  mothers  who  developed  the  flu  in  their  second  trimester.  The   second  trimester  is  vital  for  brain  development,  and  so  children  who  grow  up  developing   schizophrenia  usually  are  said  to  have  caught  the  flu  in  the  second  trimester.  It’s  also  being  in   urban  areas  that  are  environmental  factors  to  this.     We  tend  to  see  enlarged  ventricles  in  schizophrenic  patients.  When  you  have  enlarged   ventricles  it  means  that  you  have  less  brain  mass.  The  large  ventricles  shows  that  there  is  no   brain  matter  there,  and  just  enlarged  ventricles.       It’s  not  just  losing  brain  mass,  but  just  losing  connections  between  certain  brain  areas.  They  not   communicating  with  one  another.     There  is  also  a  problem  with  Lille  cell  development,  and  so  neurocommunication  is  also  slowed   down.     Personality  Disorders:     Characterized  by  interacting  with  the  world  in  maladaptive  and  inflexible  ways,  over  a  long   period  of  time,  resulting  in  social/work  problems  and  personal  distress.     So  personal  disorders  are  a  bit  controversial,  a  little  more  so  than  the  clinical  disorders.     There  is  also  a  lot  of  comorbidity  among  personality  disorders.  If  you  get  diagnosed  with  one,   your  symptoms  will  also  indicate  to  another  and  another  for  example.     They  usually  last  throughout  the  lifespan  with  no  expectation  of  significant  change.     With  all  these  personality  disorders,  they  are  divided  into  three  groups:   • Odd  or  Eccentric  Behavior,   • Dramatic,  Emotional,  or  Erratic  Behavior,   • Anxious  or  Fearful  Behavior     Borderline  Personality  Disorder:     Characterized  by  disturbances  in  identity,  affect,  and  impulse  control.     Patients  border  between  normal  and  psychotic.     In  terms  of  identity,  what  is  seen  in  these  patients  is  that  they  really  lack  a  strong  sense  of  self,   and  the  fear  abandonment,  and  they  can  be  very  manipulative  in  their  attempts  to  control   relationships.  They  have  this  excessive  fear  of  abandonment  and  they  tend  to  be  manipulative   in  their  relationships.     In  terms  of  affect,  these  people  show  profound  emotional  instability.     Impulsivity:  They  also  suffer  from  impulsive  behavior.  Self-­‐mutilation  is  also  very  common,  as   well  as  sexual  promiscuity,  physical  fighting,  binge  eating  and  purging.     To  diagnose  somebody  with  borderline  disorder,  you  have  to  have  five  of  these  nine   characteristics:   • Frantic  efforts  to  avoid  abandonment,  impulsiveness,  unstable  and  intense   interpersonal  relations,  etc.     It  is  more  common  in  women  than  in  men.  This  flips  itself  with  antisocial  personality.     There  are  biological  factors  to  borderline  personality  too.  There  are  issues  in  serotonin,  as  well   as  genetics.     Environmental  factors  have  a  thing  in  this  too.  Some  of  the  theories  is  suffering  from  sexual   abuse  as  a  child,  experiencing  physical  aggression  as  a  child,  and  the  type  of  caregiver  that  you   had,  etc.     So  there  are  a  lot  of  different  theories  out  there,  and  they  all  might  contribute  in  different   ways.     Anti-­‐Social  Personality  Disorder  (APD):     They  are  also  in  the  second  categorization  of  dramatic  behavior.     It  includes  psychopaths,  but  its  not  just  psychopathy.  Someone  with  psychopathic  behavior  are   at  the  very  extreme  end  of  this,  but  those  with  anti-­‐social  personality  disorder  are  characterized   by  a  lack  of  empathy  and  remorse.  These  are  individuals  who  behave  in  socially  undesirable   ways  and  are  often  very  hedonistic.  (I  didn’t  have  any  money  so  I  shot  that  guy  to  buy  gum).       Psychopaths  represent  the  most  extreme  version  of  APD.  These  people  are  most  often   superficially  charming  and  rational,  insincere,  unsocial,  incapable  of  love,  lacking  insight,  and   shameless.       It  is  more  common  in  men  than  women,  and  it  can’t  be  diagnosed  until  a  person  is  18,  but  you   have  to  have  shown  signs  of  antisocial  behavior  before  15.  In  particular,  it  must  be  shown  that   you  suffered  from  conduct  disorder  in  your  youth.  Conduct  disorder  is  a  disorder  associated   with  people  not  listening  to  rules  as  a  child,  which  is  a  precursor  to  antisocial  personality   disorder.     Up  to  50%  of  the  prison  population  suffer  from  antisocial  disorder.     In  terms  of  the  biological  factors,  we  know  that  it  has  a  genetic  component.  There  are  theories   that  individuals  suffering  from  this  disorder  have  lower  levels  of  arousal  and  so  they  tend  to  go   out  and  engage  in  these  extreme  antisocial  types  of  behavior  in  order  to  increase  their  arousal   levels.  There  is  also  evidence  that  these  individuals  lack  fear  and  anxiety  –  they  show  lower   levels  of  anxiety  as  compared  to  normal  people.  There  are  thus  differences  in  physiology  that   may  contribute  to  this  disorder.  The  amygdala  becomes  activated  and  so  there  is  amygdala   abnormalities  in  people  with  the  disorder  (they  tend  to  be  smaller).  There  are  deficits  in  the   frontal  lobe  functioning.     There  are  environmental  factors  too:  coming  from  a  low  socio-­‐economic  status;  dysfunctional   families;  childhood  abuse.   • Malnutrition  also  seems  to  be  a  contributing  factor  to  antisocial  personality   disorder,  and  there  was  one  study  when  they  knew  were  at  risk  of  antisocial   development,  but  if  they  went  through  a  nutritional  program,  it  greatly  diminished   the  antisociality  in  adulthood.     Childhood  Disorders:     These  are  disorders  that  are  usually  first  diagnosed  in  infancy,  childhood,  or  adolescence.     they  are  very  wide-­‐ranging,  including  everything  from  reading  disorders  to  autism.       They  need  to  be  considered  within  the  context  of  normal  childhood  development,  like  bed-­‐ wetting  even,  for  example.  Selective  mutism  is  another  one  of  these  examples.  This  is  done  by   shy  people  where  you  only  talk  to  a  select  group  of  people  in  uncomfortable  situations.  But  a   lot  of  childhood  disorders  kids  can  grow  out  of.     Assessment  can  be  challenging.  It  is  always  a  challenge  for  these  clinical  disorders.  You  have  to   get  information  from  as  many  people  as  you  can.  Getting  information  from  the  children   themselves  can  be  particularly  challenging.  They  tend  to  be  more  concrete  in  their  emotions   and  so  you  must  ask  concrete  questions.,  while  also  questioning  parents,  caregivers,  teachers.     Autism:     Autism  is  a  developmental  disorder  involving  deficits  in  social  interaction,  impaired   communication,  and  restricted  interests.       People  are  more  aware  of  it  now,  and  so  they  get  their  child  diagnosed  autism  more  often   nowadays,  and  so  this  autism  epidemic
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