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PSYC 3230 (3)

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PSYC 3230
James Check

CHAPTER 8. MOOD DISORDERS Unipolar disorders • Major Depressive Disorder • Dysthymia Major Depressive Disorder • Depressed mood or a loss of interest or pleasure in daily activities consistently for at least a two week period • Occupational, educational, or other important function must also be negatively impaired by the change in mood • Not due to alcohol, drugs, medical condition, or grief at loss of a loved one • Mean age of onset 25 years • Emotional symptoms o Extreme sadness, feelings of worthlessness o Anhedonia-- inability to find pleasure in previously pleasurable activities o Crying spells, or being "unable to cry" o Loss of feelings of affection for family/friends • Motivational symptoms o Lack of drive; markedly diminished loss of interest in almost all activities o Loss of libido o Thoughts of suicide • Behavioral symptoms o Lower activity level o Psychomotor retardation or agitation • Cognitive symptoms o Negative self-image o Negative self-talk o Guilt and self-blame o Confusion, poor memory, indecisiveness • Somatic symptoms o Disturbances in sleep-- early morning awakening, insomnia, sleeping all the time o Fatigue, exhaustion o Decrease or increase in appetite; weight change o Aches and pains, dizziness • Psychotic symptoms (severe depression) o Delusions o Hallucinations • An estimated 1 in 4 Canadians has a degree of depression serious enough to need treatment at some time in his or her life • Until age 65, twice as many women as men receive treatment for depression. Possible reasons: o The most vulnerable are single mothers with small children o Women are taught to handle stresses differently than men o Female hormones may possibly contribute to higher rates of depression o Women may be more likely to seek help • Men tend to suffer more prolonged depression than women later in life o Perhaps due to the fact that widowers tend to grieve more than widows because the wife may tend to keep many aspects of his life together (e.g., cooking, cleaning) Dysthymia • Chronic mild depression • Less disabling than Major Depressive Disorder, but more prolonged • May be associated with impaired social and/or vocational functional • Mean age of onset: early 20s • Symptoms can go unchanged for 20 years or more • Onset prior to age 20: greater chronicity Theories of unipolar depression • Psychodynamic o Depression often triggered by major loss o Due to a series of unconscious processes set in motion when people feel real or imagined (symbolic) loss o E.g., losing a job may be symbolic of losing a partner: "My husband won't want me if I can't keep a job" • Behavior theory o Depressive style of functioning is the result of a significant reduction in the total rate of reinforcements-- especially social reinforcements  Social reinforcements-- e.g., strangers smiling at you, saying "hello" • Cognitive theory (Beck) o Due to negative and distorted automatic thoughts o "Cognitive triad of depression":  Negative view of self  Negative view of environment  Negative view of future o Have patient record situations in the following categories  Situation | Interpretation | Emotion | Physical response | Action | Outcome o Negative thoughts produce negative feelings and negative actions, leading to negative outcomes • Learned helplessness model (Seligman, Peterson, et al.) o Individuals learn that their actions do not bring about any positive results  Attributions may play a role in learned helplessness o When people perceive circumstances to be beyond their control, they may attribute this to stable, internal causes, leading to depression  An attribution to unstable, external causes may help avoid depression Bipolar disorders • Formerly called "manic-depressive psychosis" Mania • May involve frenzy, anger, laughing binges, racing and disjointed thoughts, agitation, over-talkativeness, impulsivity • May involve delusions (grandeur, erotomania [e.g., believing that famous people are in love with you]) or even hallucinations • May cycle from mania to depression, with or without intervening normal periods • Questions a psychologist may ask re: mania o Was there ever a time when you:  Stayed very excited (e.g., for days)?  Were too happy without reason?  Were too full of energy?  Talked too much and couldn't stop?  Went without sleep for a day or two?  Seemed to be "oversexed"?  Spent money recklessly, gave costly gifts?  Overworked-- had several jobs at the same time?  Couldn't stop your mind from racing? Bipolar disorder • A person with Bipolar Disorder on average experiences 10 episodes of mania or depression in his/her lifetime • If there are four or more episodes of such mood disturbances in a year, this is referred to as "rapid cycling" • Bipolar I: One or more manic episodes, usually, but not necessarily, in people who have had a Major Depressive Episode • Bipolar II: Depression plus hypomanic episode, but not full-blown manic episode Causes of bipolar disorders • Causes not totally understood • Appears to be a strong genetic predisposition • Researchers have isolated specific genes related to Bipolar that may be responsible for regulating neurotransmitters • Physiological predisposition interacts with social and psychological factors Cyclothymia • Thymia: Greek word for the mind • A chronic bipolar disorder consisting of short periods of mild depression and short periods of hypomania (lasting a few days to a few weeks), separated by short periods of normal mood • Never free of symptoms of either depression or hypomania for more than two months at a time • About 30% of individuals with Cyclothymia experience a full-blown manic episode or major depression and have their diagnosis changed to either Bipolar I or Bipolar II Post-partum Depression • "Mood disorder with post-partum onset" • Average prevalence 13% • Women are at highest risk for depression, in terms of age, at same age they are most likely to be having children o Can produce problems with attachment and emotional/cognitive development in children that can extend beyond preschool years • Can be largely prevented by prenatal and postnatal counseling/therapy Treatment of mood disorders • Mood disorders are very treatable • Psychodynamic o Goal is to bring to consciousness grief over real or imagined losses o Employ free association, dream analysis • Behavioral o Therapist guides client towards once-pleasurable activities o Reinforces non-depressive behaviors o Social skills training • Cognitive o Helps client identify, understand and change dysfunctional thoughts  Challenges…  Negative thoughts  Irrational beliefs  Misattributions about self or others  Idealistic expectations (e.g., that people should be happy all the time) • Pharmacological o Antidepressants  Tricyclics (TCAs)  MAOI  SSRI (SSRIs are more effective than TCAs and have better safety and compliance profiles ) o Lithium-- a salt • Physiological o Electroshock therapy (ECT) is still used in rare instances to relieve severe depression  Side effects may include memory loss Suicide • A leading cause of death worldwide • Official statistics likely to underestimate the actual number of suicides (suicides are easy to camouflage, e.g., car accidents) • Canada's overall suicide rate about 14 per 100,000 people • U.S. rate 12 per 100,000 • About 3800 suicides in Canada each year • The rate is much higher for aboriginals • The rate for men is much higher than women • Methods of suicide vary from culture to culture • Hanging-- leading method of suicide worldwide • In the United States, about 60% of all suicides are committed with guns • 30% in Canada • Poisoning (e.g., overdose of medication) accounts for about 18% of suicides • About 90% of all suicides are by people suffering from diagnosable mental illnesses • Majority who kill themselves suffer from depression that is often undiagnosed and untreated • Bipolar disorder, schizophrenia, and anxiety disorders may also contribute to suicidal behavior • Physical illness also increases a person's risk of suicide • Only 15 to 25% of those who kill themselves leave suicide notes • But about 80% percent of people who complete suicide show warning signs • Danger signs include giving away prized possessions Suicide prevention 1. Suicide-prevention hotlines 2. Education 3. Restricting access to means of killing oneself o Barriers that prevent people from jumping off bridges, restrictions to access to firearms CHAPTER 9 SCHIZOPHRENIA Schizophrenia One end: -Isolated Other: -Harms people in self defense Message from God that the demons are coming, have to save the world • In a sense acting rationally in a weird kind of way because they believe what they’re hearing is true -Literally means “split mind” -Relating to mind -Rather, it refers to a split, or break in the mind, emotions and cognitions. -1 % of the population. -Most of the time occurs around 15 and 25years old -Used to be called dementia preocox. -Not all genetic - schizophrenia spectrum -Schizophrenia Society of Canada: Treatable, biochemical brain disease strikes 1 in 100 normal intelligent people, causes 40-60% to commit suicide. -Symptoms: Disordered thinking Disordered behavior-mannerisms that are inexplicable Loosely ordered thoughts Delusions -some are grandiose Voices (ie. You raped that woman) -Sometimes tell him to do things, that he has to leave -Distress and scare him -History of the diagnosis of schizophrenia Emil kraeplin was one of the first people to classify schizo as a separate disorder • 1893-called it dementia praecox -early onset dementia • Believed it begins early in life and gradually leads to total disintegration of the personality. • Used to spend time in strait jackets, seems inhumane now but difficult to treat -Thought that recovery is impossible to organic deterioration -Later added subgroups: catatonic Catatonic: • Waxy flexibility, stupor, odd posturing, excitement, echopraxia, echolalia - Hebephrenic • Grimaces, incoherence, extreme oddities of beh, grossly disorganized beh, flat or grossly inppropriate affect -Paranoid • Delusions, hallucinations, unfocused anxiety, anger • These are the ones who usually end up hurting others -Eugene Bleuler emphasized the psychological aspects of schizophrenia - Gave it the name schizo • Four A’s of schizo: • Affect, Associations(loose speech, disorganized thoughts), Autism (self- centered notion, talking in a way apparently only he or she can understand, have a world of their own), Ambivalence(emotions) -Bueler added a fourth type of schizo, simple schizo • Extreme social withdrawal, flattening of affect, impoverishment of language -Kurt Schneirder • Felt Bleuler’s four A’s were too vague • Delusions and hallucinations (“First Rank” symptoms) • Mood disturbance, confused thinking (“Second Rank” symptoms) • But these symptoms can also appear in other disorders-manic disorder, for example • Positive: thinks that are present • Negative: subtracted from the person, ie. Flat affect, poverty of speech, loss of directedness... -Symptoms in DSM • impaired social/work/family functioning Two or more symptoms present at least a month : • Delusions • Hallucinations-auditory or visual • Speech marked by incoherence (neologisms, clanging) or loosening of associations • Disorganized or catatonic behavior -must rule out medical condition or substance abuse - Must rule out schizoaffective and mood disorders • Cross between mood and schizophrenia • If person is showing a lot of signs of depression, then schizoaffective -If symptoms occur, but last between one and six months, label is schizophreniform disorder-label will change to schizophrenia if disorder endures. -If symptoms last for a day but less than a month, referred to as brief psychotic disorder -Subtypes: • Paranoid type: Delusions, auditory hallucinations • Disorganized type:Hebephrenic, disorganized speech, etc • Catatonic type: Extreme negativism, mutism, purposeless excessive motor • Undifferentiated type • Residual type • Related disorder: delusional disorder Involve the continuing presence (for at least a month) of a non-bizarre delusion • No marked impairment • No symptoms of schizophrenia • Onset often In middle or later life, although earlier signs include social/interpersonal problems • Delusions may be of grandeur, erotomanic, persecutory, jealousy Delusions are false beliefs, strongly held despite strong contradictory evidence Hallucinations are perceptual: they are false perceptions, and may occur in any sensory modality. Causes of Schizophrenia: Causes not known, -No particular gene identified Other biological factors: -Prenatal or obstetric complications -Brain structure -Excess of dopamine in synapses Prior to 1950’s, it was a life sentence, you would spend most of your life in a mental health institution Therapists experimented with various therapies -Psychoanalysis: useless -Psychosurgery: attempts were made, even in the middle ages, to alleviate “madness” by surgery on the brain -In modern times, a needle was inserted through eye socket to remove part of prefrontal cortex -Development of antipsychotic drug treatment changed the lives of people with schizophrenia; they could live outside the asylum • Yet, this does not mean that they lead normal lives; outcome is generally poor. • Yet some show so much improvement that they get off the drugs and are virtually symptom free - Sufferers need more than just drugs • Also, many stop the medication because of side effects • Cognitive therapy, group therapy, family therapy, skills training can all help person cope with the disorder -However, even after the hallucinations are stopped, the voices in the head are silenced, most sufferers suffer from significant cognitive defects • Make it hard to process information/remember/plan • Often leads to despair, and all too frequently, to suicide -Becoming more and more clear that cognitive deficits are more debilitating than the hallucinations Thought broadcasting - strong belief that everybody can hear your thoughts CHAPTER 12. PERSONALITY DISORDER What is a personality disorder? • Enduring pattern of inflexible and maladaptive thinking, feeling, and acting that cause significant subjective distress and/or impairment in social or occupational functioning • Contrasted with personality traits: pattern of experiencing and interacting with environment and other people • Boundary is inherently blurry General diagnostic criteria • Enduring pattern leads to distress, impairment in important areas in functioning or causes others distress • Onset usually late childhood, early adolescence • Pattern is stable and of long duration • Pattern not better explained by another disorder • Pattern not due to substance abuse or a general medical condition Diagnosed on Axis II in DSM-IV • Long-lasting, chronic patterns of interaction • Complete recovery not possible Types of personality disorders • Cluster A • Marked by eccentricity, odd behavior, not psychosis • Share a superficial similarity with schizophrenia o Paranoid personality o Schizoid personality o Schizotypal personality • Cluster B o Being self-absorbed, prone to exaggerated importance of events o Having difficulty maintaining close relationships o Antisocial personality o Borderline personality o Histrionic personality o Narcissistic personality • Cluster C o Chronic symptoms :anxiety, fearful, obsessive compulsive o Avoidant personality o Dependent personality o Obsessive-compulsive personality Paranoid personality disorder • Suspects that others are exploiting, harming, or deceiving him or her • Suspects that others are exploiting, harming, or deceiving him or her • Preoccupied with unjustified doubts about trustworthiness of friends and others • Reluctant to confide in others fearing any information will be used maliciously against him or her • Reads hidden demeaning or threatening meanings into benign remarks or events Schizoid Personality Disorder • 7.5% of population • 2-to-1 male-to-female ratio • Neither desires nor enjoys close relationships, including being part of a family • Almost always chooses solitary activities • Little or no interest in having sexual experiences with another person • Lacks close friends or confidants other than first-degree relatives Schizotypal personality disorder • 3% of the population • Sex ratio is unknown • Greater association among biological relatives of schizophrenic patients • Enduring pattern of discomfort with others and odd, peculiar thinking and behavior • Shares symptoms with both paranoid and schizoid personality disorders • The premorbid personality of the schizophrenic patient • Ideas of reference • Odd beliefs inconsistent with subcultural norms • Unusual perceptual experiences, including bodily illusions • Odd thinking and speech (e.g., vague, over-elaborate) • Suspiciousness • Inappropriate or constricted affect • Behavior or appearance that is odd, eccentric, or peculiar • Lack of close friends or confidants other than first-degree relatives • Excessive social anxiety due to paranoid fears rather than being negatively evaluated Antisocial personality disorder • 3% in men and 1% in women • Consistent irresponsibility--e.g., pattern of financial irresponsibility; erratic employment history; reckless disregard for safety of self or others • Lack of remorse--e.g., indifferent to effects of hurting, stealing from others • Antisocial behavior--e.g., repeatedly performing acts that are grounds for arrest • Deceitfulness--repeated lying, using of aliases, or conning others for personal profit or pleasure • Impulsivity--failure to plan ahead • Irritability and aggressiveness, as indicated by repeated physical fights or assaults • Age 18 years, and evidence of Conduct Disorderwith onset before age 15 years Borderline personality disorder • 1-2% of the population; twice as common in women than in men • Pattern of unstable and intense interpersonal relationships--alternating between extremes of idealization and devaluation • Frantic efforts to avoid real or imagined abandonment • Identity disturbance--markedly and persistently unstable self-image or sense of self • Chronic feelings of emptiness • Impulsivity that is potentially self-damaging (e.g., spending, sex, substance abuse, reckless driving, binge eating) • Recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior • Inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights) • Transient, stress-related paranoid ideationor severe dissociative symptoms • Affective instability due to a marked reactivity of mood (e.g., intense episodic dysphoria) Histrionic personality disorder • 2-3% of population; diagnosed more frequently in women than in men • Uncomfortable when not the center of attention • Consistently uses physical appearance to draw attention to self • Interaction with others often characterized by inappropriate sexually seductive behavior • Displays rapidly shifting emotions • Speech style impressionistic and lacking in detail • Self-dramatization, theatricality, and exaggerated expression ("drama queen") • Suggestible--readily influenced by others • Views relationships as more intimate than they actually are • Tends to be associated with Somatization Disorder and Alcohol Abuse Narcissistic personality disorder • 1% of the general population • Grandiose sense of self-importance • Preoccupied with fantasies of unlimited success, power, brilliance, beauty, or ideal love • Sense of entitlement (expects favorable treatment or automatic compliance with his/her wishes) • Exploitative--takes advantage of others to achieve his or her goals • Lacks empathy--unwilling to the feelings and needs of others • Often envious of others--or believes that others are envious of him or her Avoidant personality disorder • 1-10% of the population; no information on sex ration or familial pattern • Feels socially inept or personally unappealing, or inferior to others • Preoccupied with being criticized or rejected in social situations o Avoids involvement with people unless certain of being liked o Avoid occupational activities that involve much interpersonal contact, fearing criticism or rejection o Restrained regarding intimate relationships for fear of being shamed or inadequate • Very reluctant to take personal risks or to engage in any new activities because they may prove embarrassing • Infants with a timid temperament may be more likely to develop Avoidant DP Obsessive-compulsive personality disorder • Epidemiology is unknown, more common in women than men • Goes to excessive lengths to obtain nurturance and support from others • Feels uncomfortable or helpless when alone because of exaggerated fears of being unable to care for himself or herself • Difficulty making everyday decisions without excessive advice/reassurance • Needs others to assume responsibility for him/her • Difficulty expressing disagreement with others because of fear of loss of support or approval • Difficulty initiating projects or doing things on his or her own (due to lack of self-confidence in judgment or abilities) • Children with chronic physical illnesses may b
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