Chapter16 PowerPoint.ppt

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Chapter 16

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Progress in Abnormal Psychology

• The growth of understanding of mental disorders and their treatment has paralleled the progress of medical science.

• Although we have much yet to learn, we now can make accurate distinctions between a wide range of disorders and we can tailor treatments to meet the needs of those suffering from

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Module 16.1 • Anxiety Disorders

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Disorders with Excessive Anxiety

• Anxiety refers to a certain amount of fear and caution in the face of potential hazards.

– A certain amount of anxiety is normal.

– Anxiety is considered pathological when it interferes with daily functioning.

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Disorders with Excessive Anxiety • Generalized anxiety disorder

– Generalized anxiety disorder (GAD) is the

experience of almost constant and exaggerated worry.

• There is no basis for the worries but the person is tense, irritable and tired.

• About 5% of the general population will experience GAD.

• Often it is co-diagnosed with other mood disorders such as depression.

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Disorders with Excessive Anxiety • Panic disorder

– Panic disorder (PD) is characterized by frequent periods of anxiety and occasional attacks of panic.

• Panic attacks involve rapid breathing,

increased heart rate, chest pains, sweating, trembling and faintness.

• Panic attacks usually last just a few minutes, but can be much longer.

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– Panic disorder is experienced by 1-3% of adults and occurs in many cultures.

– More women than men are diagnosed with Panic Disorder.

– Hyperventilation, or rapid deep breathing, is a key symptom.

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– Hyperventilation causes the body to react as if suffocation were occurring.

– The person’s interpretation of the symptoms of hyperventilation can cause an increase in panic or a calming down.

– People with panic disorder tend to interpret them as uncontrollable and life threatening.

– Their constant anxiety increases the likelihood of attacks.

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Disorders with Excessive Anxiety • Panic disorder

– Treatments for panic disorder include: • Psychotherapy

• Anti-depressant drugs

• Advice: “Don’t worry about panic attacks; they won’t kill you.”

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Disorders with Excessive Anxiety • Panic disorder

– Common co-existing disorders include:

• _{Social phobia}_{– severe avoidance of other} people and fear of doing anything in public. • _Agoraphobia_{– an intense fear of open or}

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Disorders with Excessive Avoidance • Phobias

– Avoidance behaviors are highly resistant to extinction.

– Phobia is the most common type disorder involving avoidance behaviors.

– A phobia is strong and persistent fear of a specific object or situation – so strong it interferes with daily living.

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– The Prevalence of Phobias

• Not all extreme fears qualify as phobias.

• About 11% of U.S. adults suffer from a phobia at some point in their lives.

• About 5-6% are experiencing a phobia at any given time.

• Phobia usually does not persist across the lifetime – many young adults lose them by middle age.

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Figure 16.1

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– Acquiring a phobia:

• Some fears are innate but many are

learned – even traced to a specific event. • The early behaviorists were the first to

demonstrate how fears might be learned. • This does not account for the fact that

some phobias are much more common and easily acquired than others.

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Disorders with Excessive Avoidance

• Common phobias include: • Open spaces

• Public speaking • Heights

• Not being on solid ground • Social phobia

• Being alone

• Reminders of danger: (lightening, thunder,

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Figure 16.3

Figure 16.3 A lab-reared monkey learns to fear snakes from the reactions of a wild-reared monkey. But if the snake is not visible, the lab-reared monkey fails to learn any fear.

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– Behavior therapy for phobias

• _{Systematic desensitization}_{– gradual} exposure to the object under controlled conditions. Virtual reality is now being employed for this kind of therapy.

• _Flooding_or_implosion_{– a sudden and} large-scale exposure to the object under controlled conditions.

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– Drug therapies for phobias and anxieties • _{Benzodiazepines}_{, a common type of}

tranquilizer, are often prescribed.

• They suppress symptoms only temporarily and can be addictive.

• Anti-depressants, which are not likely to be taken habitually, are used more effectively.

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Disorders with Excessive Avoidance • Obsessive-compulsive disorder

– There are two symptoms that comprise it: • Obsessions are repetitive, unwelcome

streams of thought.

• _Compulsions_{are repetitive, almost irresistible} actions.

• Obsessive thoughts lead to compulsive actions.

• Checking and cleaning are two very common compulsive behaviors.

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Disorders with Excessive Avoidance • Obsessive-compulsive disorder

– Therapies for obsessive-compulsive disorder: • _{Exposure therapy}_{is very similar to}

systematic desensitization.

• The patient is exposed to the situation that brings on the compulsive behavior, but is prevented from engaging in it.

• The most common drug treatments for this disorder utilize clomipramine and other

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Anxieties and Avoidance

• Phobias and anxiety disorders involve the interaction and influence of cognition and emotion upon each other.

• People who suffer from these conditions are aware that their reactions are exaggerated, but this awareness

doesn’t cure the problem.

• These disorders are challenging but psychologists

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Module 16.2 • Substance-Related Disorders

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Substance Dependence (Addiction)

• Individuals who find it difficult or impossible to quit a dangerous habit are said to have an

addiction to it or a dependence on it.

• People vary widely in how this affects their daily lives and functioning.

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Substance Dependence (Addiction) • Nearly all addictive drugs stimulate the

dopamine receptors in the nucleus accumbens.

• Activation of these synapses causes increased attention.

• This activation is accompanied by feelings of great pleasure.

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Substance Dependence (Addiction) • There are two symptoms involved in the

development of a drug addiction.

– Tolerance – decreased effects of a given dose. – Withdrawal – unpleasant sensations when the

drug is not used (or too little is used given the development of tolerance).

– Activities and substances that are not drugs can produce addictions – suggesting that addiction is a function of the person, not the drug alone.

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Figure16.6

• Figure 16.6: The nucleus accumbens is a small brain area that is critical for the motivating effects of many experiences, including drugs, food and sex. Most abused drugs increase the activity of the neurotransmitter dopamine in this area.

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Substance Dependence (Addiction) • Is substance dependence a disease?

– It depends in part on how we define “disease.” – Psychologists currently favor the use of

continuum from “no addiction” to “severe addiction.”

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Substance Dependence (Addiction) • Nicotine dependence

– Cigarette smoking is based on nicotine addiction.

– People are generally able to quit smoking

more easily if they have a replacement source of nicotine (i.e. a patch).

– Low-nicotine/low-tar cigarettes do not help people to quit.

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Figure 16.7

Figure 16.7 “Low-nicotine” cigarettes have a row of small holes in the filter to let room air dilute the tobacco smoke. However many smokers cover the holes with their fingers.

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Substance Dependence (Addiction) • Alcoholism

– Alcoholism is defined as the habitual overuse of alcohol.

– Treatment of chronic alcoholism is very difficult. – In order for treatment of alcoholism to be

effective, we need to detect the problem in its early stages.

– We need to identify the factors that put certain people at risk.

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Substance Dependence (Addiction) • Alcoholism

– Type I alcoholism develops gradually over the lifespan.

– It is equally prevalent in men and women. – It is generally less severe in its health

consequences.

– _{Type II alcoholism}_{has an early onset.}

– It is much more prevalent in men and more severe.

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Table 16.3

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Substance Dependence (Addiction) • Alcoholism: Risk factors

– Research studies indicate that tendency to addiction is influenced by genetics.

– Type II alcoholism shows a strong genetic basis.

– Some people with no family history of alcoholism develop an alcohol problem.

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Substance Dependence (Addiction) • Alcoholism: Risk factors

– Exposure to parental conflict, inadequate supervision, and abuse can increase the

likelihood of alcoholism emerging later in life. – Culture also has an influence – prevalence

rates vary in different nations and ethnic groups.

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Substance Dependence (Addiction) • Treatment for alcoholism

– It is very difficult for most people to quit alcohol and the other drugs.

– Only 10-20% are successful and relapses are very common.

– Many recovering addicts seek help from

mental-health professionals or self-help groups. – Such help improves the chances of successful

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Substance Dependence (Addiction) • Treatments for alcoholism

– The most widespread treatment for alcoholism is offered by Alcoholic Anonymous (AA).

– AA is a self-help group comprised of people who abstain from alcohol use and offer help and support to each other.

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– Antabuse is the trade name for disulfiram. – Alcoholics who take Antabuse daily become

very sick when they drink alcohol.

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– Controlled drinking refers to reducing

consumption of alcohol from dependent/abusive to moderate levels.

– Some physicians believe that abstinence is

workable for all alcoholics and believe this is a viable alternative.

– Harm reduction is a similar approach applied to drug abuse.

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Substance Dependence (Addiction) • Opiate dependence

– A very difficult withdrawal syndrome

complicates recovery from dependence on opiate drugs (i.e. heroin, morphine).

– Some opiate addicts go “cold turkey” in order to stop using.

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Substance Dependence (Addiction) • Opiate dependence

– Recovery programs commonly offer

methadone as a less dangerous replacement for opiates.

– This is a harm reduction strategy that allows recovering opiate addicts to remain employed and avoid criminal behavior.

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Table 16.4

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Substances, the Individual, and Society

• How we handle the problem of substance dependence and abuse in our society remains an area of intense debate.

• Our current strategies have not eliminated widespread use.

• As a citizen, you may be called upon to think about

these issues and help to shape changes in our national drug policy. As you have learned, there are complex and difficult issues involved.

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Module 16.3 • Mood Disorders

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Mood Disorders • Depression

– Major depression

• _{Major depression}_{is an extreme condition.} • It usually persists for months.

• The person experiences little interest in

anything, little pleasure, and little motivation to be productive.

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– Major depression

• Loss of interest in food and sex.

• The person has feelings of worthlessness, guilt and powerlessness over their lives.

• Sleep abnormalities are associated with depression (there is a rapid onset of REM sleep).

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Figure 16.9

Figure 16.9 When most people go to sleep at their usual time, they progress slowly to stage 4 and then back through stages 3 and 2, reaching REM sleep toward the end of their first 90-minute cycle. Depressed people enter REM sooner and awaken frequently during the night.

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– Seasonal affective disorder (SAD)

• Depression associated with a particular season of the year is called seasonal affective disorder.

• It is most common in areas that have little sunlight in the winter.

• _{Light therapy}_{, which requires the person} to sit in front of a bright light for a few hours each day, is effective for treating SAD.

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Figure 16.10

Figure 16.10 Most people feel slightly better during the summer than during the winter. The differences are greater for people with seasonal affective disorder (SAD).

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– Bipolar disorder

• This condition was once referred to as manic-depressive disorder.

• It involves a cycling of mood between periods of depression and mania.

• Mania is a state of extreme exuberance and agitation.

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– Genetic predisposition to depression

• Having close biological relatives who were diagnosed with depression increases one’s probability of becoming depressed.

• Having adoptive relatives who were

depressed also increases that probability, but not as much.

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– Genetic predisposition to depression

• The probability is especially high if one has biological relatives who were diagnosed

with depression before age 30.

• There is probably no one gene that causes depression.

• Genes influence temperament thus also the way people respond to events in their lives.

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– Sex differences in depression

• Before adolescence, depression is about equally common in boys and girls.

• From adolescence onward, women are about twice as likely to experience

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– Sex differences in depression: hormones • Women experience more rapid hormonal

changes than men do (menstrual cycles, pregnancy, childbirth and menopause). • Yet the hormone levels of depressed

women are not significantly different that those of non-depressed women.

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– Sex differences in depression: coping

• Men generally try to distract themselves when they are feeling depressed. Women tend to dwell on their feelings more.

• Ruminating is not useful for coping and may make the person feel worse.

• This doesn’t explain why women and men choose different strategies.

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– Events that precipitate depression

• People generally become depressed after losses or other negative events occur.

• There is little relationship between the scale of the event and the intensity and duration of the depression.

• Severe losses early in life may make

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Mood Disorders

• Depression

– Events that precipitate depression

• Lack of social support also increases vulnerability to depression.

• As in the case of stress, it is not just the event but also the person’s interpretation of the event’s significance that influences the degree of

depression.

• The way people think about their lives, as well as the course of the events, is a factor to consider.

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– Cognitive aspects of depression

• Every person has an explanatory style in accounting for successes and failures.

• _{Internal attributions}_{cite causes within the} person.

• _{External attributions}_{identify causes} outside the person.

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• People tend to be more consistent in the type of attributions that they use to explain their failures.

• People who blame themselves for all

failures, regardless of the circumstances, develop a pessimistic explanatory style.

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• They view their failures as global

(consistent over situations) and stable (consistent over time).

“Depressed people believe that every silver lining has a cloud.”

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Mood Disorders

• Depression

– Treatments for depression

• Cognitive therapy helps the individual develop more positive beliefs.

• Antidepressant medications such as tricyclics, selective serotonin reuptake inhibitors,

monoamine oxidase inhibitors, and atypical antidepressants.

• St. John’s Wort is an herb that has

antidepressant effects. It should not be used with other medications.

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Figure 16.14

Figure 16.14 Ordinarily, after the release of one of the neurotransmitters, some of the molecules are reabsorbed by the terminal button, and some are broken down by the enzyme monoamine oxidase (MAO). (b) Selective serotonin reuptake inhibitors (SSRIs) prevent reabsorption of serotonin. Tricyclic drugs prevent reabsorption of dopamine, norepinephrine, and serotonin. (c) MAO inhibitors (MAOIs) block the enzyme monoamine oxidase and thereby increase the availability of the neurotransmitter.

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• _{Electroconvulsive shock therapy (ECT)} is a well-known but controversial treatment. • A brief electrical shock is administered to

the patient’s head.

• It induces a convulsion similar to an epileptic seizure.

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• It is an effective treatment, although the benefits are temporary.

• ECT fell out of favor because it was widely

abused (administered without patient consent, given too often, used as a threat).

• It is now used only for patients who have treatment-resistant depressions or who are strongly suicidal.

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Mood Disorders • Bipolar disorder

– Bipolar disorder: symptoms

• People whose moods alternate between extremes of mania and depression suffer from bipolar disorder.

• When experiencing mania, they are

constantly active and uninhibited, and may be very happy or very irritable.

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Mood Disorders • Bipolar Disorder

– Bipolar Disorder: two types

• _{Bipolar I disorder}_{involves the experience} of at least one episode of mania.

• _{Bipolar II disorder}_{involves alternation} between major depression and

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– Bipolar disorder: prevalence

• About 1% of the adult population of the U.S. has been diagnosed.

• It can be difficult to distinguish bipolar from other disorders (attention deficits, delusions and hallucinations occur in other disorders). • There are hereditary influences on bipolar

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– Drug therapies for bipolar disorder

• _Lithium_{is a naturally occurring chemical} that is used to treat mania.

• How it works is not well understood.

• Lithium is toxic at high doses so patients must be carefully monitored.

• _Valproate_and_{anticonvulsant drugs}_are also used to treat bipolar disorders.

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Mood Disorders • Suicide

– Mood disorders and suicide

• People who suffer from depression and bipolar disorders consider suicide. Some make attempts.

• It is hard to know the true rate of suicide

because some suicides are disguised to look like accidents.

• Suicide rates vary as a function of gender, culture and age

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Table 16.5

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• Women make more attempts but tend to employ less lethal means than do men.

• There is no dependable pattern to suicide, but certain warning signs and risk factors are

associated with it.

• Previous attempts, a history of losses, a

recent loss, and a family history are all likely to raise the risk.

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• If someone you know is thinking of suicide, try to treat the person as you would any

other person who is in distress.

• Offer support and friendship, and don’t be afraid to encourage expression of feelings. • Encourage the person to seek professional

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Mood and Mood Disorders

• Our capacity to experience emotions is an important part of our lives. We have a wide range of pleasant and unpleasant feelings to color our days.

• Mood disorders go beyond this typical spectrum, and victimize the person, distorting their

perspective. Our ways to manage these

disorders have improved over the past decades, providing many with relief from this distortion.

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Module 16.4 • Schizophrenia

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Schizophrenia • What is schizophrenia?

– Many people confuse the term schizophrenia with dissociative identity disorder or multiple personality disorder.

– The split in schizophrenia refers to a

disconnection of the intellectual and emotional aspects of the personality.

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Figure 16.16

Figure 16.16 The term schizophrenia, derived from Greek roots meaning “split mind,” refers to a split between the intellectual and emotional aspects of a single personality.

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Schizophrenia

• What is schizophrenia?

– The DSM-IV diagnosis requires a complete

deterioration of daily activities and at least two of the following symptoms:

• Hallucinations

• Delusions or thought disorders • Incoherent speech

• Grossly disorganized behavior

• Loss of normal emotional responses and social behaviors

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Schizophrenia • Symptoms of schizophrenia

– It is possible for two people with schizophrenia to have very different symptom patterns. There are two broad types:

• Positive symptoms are behaviors that are

notable because of their presence

(hallucinations and delusions, for example).

• Negative symptoms are behaviors that are

notable because of their absence (lack of emotional expression).

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– Positive symptoms

• _{Hallucinations}_{are false sensory} experiences.

• Hearing voices is a common auditory hallucination of schizophrenia.

• Visual hallucinations occur but are less common.

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• _Delusions_{are unfounded beliefs.} • There are three types of delusions:

persecution, grandeur, and ideas of reference.

• As it is sometimes hard to distinguish

between unusual opinions and delusions, one cannot diagnose a psychotic disorder on this basis alone.

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• _{Disordered thinking}_{refers to a deficit in} utilizing “executive functions.”

• Deficits of attention, difficulty in switching rules and routines, loose associations, and difficulties with abstraction are all common types of disordered thinking in people

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Schizophrenia • Types and prevalence

– Four types of schizophrenia • _{Undifferentiated}

• _Catatonic

• Disorganized • Paranoid

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Schizophrenia • Four types of schizophrenia

– The symptoms of undifferentiated schizophrenia include:

• Deterioration of daily functioning • Hallucinations

• Delusions or thought disorders • Inappropriate emotions

– None of the symptoms is unusually pronounced or bizarre.

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– Catatonic schizophrenia is distinguished by

prominent movement disorder, including either: • Rigid inactivity

• Excessive activity

• The person is aware of surroundings, but the nature of the individual’s posture or

movement has no relationship to the outside world.

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– The symptoms of disorganized schizophrenia include:

• Incoherent speech

• Extreme lack of social relationships • “Silly” or odd behavior

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– The symptoms of paranoid schizophrenia include:

• Elaborate hallucinations and delusions

• The delusions have pronounced themes of persecution and grandeur.

• Other thought problems are less

pronounced. Some people with this type are relatively intact cognitively.

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Schizophrenia • Prevalence

– Prevalence of schizophrenia

• About 1% of Americans are afflicted with schizophrenia at some time.

• The rates of this disorder have been declining over the past 100 years.

• It occurs in many cultures, but is less common in developing nations.

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Schizophrenia • Prevalence

– Prevalence of schizophrenia

• Schizophrenia is most frequently diagnosed in young adults.

• Men are usually diagnosed earlier than women.

• The onset is typically sudden, although there are some markers during childhood.

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Schizophrenia • Causes

– Genetic influences

• Studies of twins and adopted children suggest a genetic basis for the disease.

• In identical twins, if one develops the

disorder, there is a 50% chance that the other will also.

• As with most other genetic research, it is

difficult to control for prenatal environmental effects.

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Figure 16.19

Figure 16.19 The relatives of a schizophrenic person have an increased probability of developing schizophrenia themselves. (Based on data from Gottesman, 1991)

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Schizophrenia

• Causes

– Genetic influences

• So far researchers have not located a specific gene for schizophrenia.

• It is probably not a single-gene disorder.

• It appears that certain people develop it without a genetic basis.

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– Brain damage may have some influence on the development of schizophrenia. Brain

scans indicate:

• The hippocampus and parts of the cerebral cortex are a little smaller than normal.

• Larger than normal cerebral ventricles.

• Smaller neurons and fewer synapses in the prefrontal cortex.

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– The neurodevelopmental hypothesis

• States that schizophrenia is the result of nervous system impairments that develop before or at birth.

• They may be due to genetic or other reasons. • Non-genetic risk factors include: poor prenatal

care, difficult pregnancy and labor, and mother’s exposure to influenza virus.

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Schizophrenia • Therapies for schizophrenia

– Drug therapies

• _{Antipsychotic}_or_{neuroleptic drugs}_help to relieve the symptoms of schizophrenia. • These drugs work gradually and vary in

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– Drug therapies

• Antipsychotic drugs block the production of dopamine at the synapses, which is

evidence for the dopamine hypothesis of

schizophrenia.

• Deficient stimulation of glutamate (a neurotransmitter that is inhibited by

dopamine) is an alternative neurochemical explanation for the disorder.

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– Drug therapies

• Tremors and involuntary movements are seen in people taking antipsychotics for many

years, a condition called tardive dyskinesia. • _{Atypical antipsychotic medications}_have

been developed to eliminate this effect.

• But these drugs tend to suppress immune functioning in many patients.

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– Family therapy for schizophrenia

• Because caring for a schizophrenic family member can be stressful, family therapy can be beneficial.

• It provides direct support for the healthy family members.

• It reduces the risk to the patient,

circumventing negative reactions by family members that might promote relapse.

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Figure 16.21

Figure 16.21 After recovery from schizophrenia, the percentage of schizophrenic patients who remained improved for the next 2 ½ years was higher in the group that received continuing drug treatment than in the placebo group. (Based on Baldessarini, 1984)

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The Elusiveness of Schizophrenia

• Two people with schizophrenia may present

their illness in very different ways. The causes of their illnesses may turn out to be very different. • Psychologists are still uncertain whether we are

looking at one disorder or several. We still have so much to learn about this complex illness.