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Psychological Disorders
Definition, diagnosis and treatment
What constitutes a disorder?
• Behavior is ___________
• Behavior is ___________
• Behavior is ___________
Understanding psychological disorders through the ages
• Ancient Greece: imbalance of the “four humours”
• Dark ages-Middle ages: devil or witchcraft
• 18th century: medical (biological) model of disease
• 20th century: biopsychosocial model of psychological disorders
Classification of disorders
• DSM-IV-TR - diagnostic manuals used by clinicians– Symptoms– Labels– Prognoses– Sample cases– Statistics
Anxiety disorders
• Characterized by feelings of excessive apprehension and anxiety– Generalized anxiety disorder– Phobic disorders– Panic disorder– Obsessive-compulsive disorder– Post-traumatic stress disorder
Generalized Anxiety disorder
• Symptoms-
-
-
• Prevalence
• Treatment
Phobic disorders
• Persistent and irrational fears– Social phobias
– Specific phobias• Acrophobia, claustrophobia, hemophobia,
pyrophobia, triskadekaphobia, ophidiophobia, astraphobia, nyctophobia, aichmophobia, coulrophobia, trichophobia…
Treatment for phobias
• Exposure– Systematic Desensitization– Flooding– Imaginal vs. In Vivo
• Classical Conditioning Rationale• Anxiety hierarchy
– Subjective Units of Distress (SUDS)
• Response prevention– Safety Cues
Panic disorder
• Panic attacks– Symptoms
– Not:
– May result in agoraphobia
Treatment for Panic Disorder
• Exposure is still used, but this time the cue for the fear is _________________. – Hypervigilance
• Exposure Techniques:– – –
• Breathing Retraining and Muscle Relaxation
Obsessive-Compulsive disorder
• Persistent obsessions and compulsions– Obsession =
– Compulsion =
Treating OCD
• Exposure with Ritual Prevention– Operational conditioning of fear through avoidance– Self Monitoring– Block compulsion responses to anxiety
• Cognitive Restructuring– Catastrophic Thinking
• Psychopharmacology– Clomipramine (anafranil). Fluoxetine (prozac),
Fluvoxamine (luvox)
Post-Traumatic Stress disorder
• Result of severe trauma and emotional distress.– Symptoms
– Lasting 4+ weeks
• Relies on (lack of) emotional resilience
Treating PTSD
• Prolonged Exposure– Expose to memories and cues related to
trauma– Imaginal: recite memories in first person
repeatedly until SUDS go down.– In vivo: spend time in similar environments
that create anxiety related to the trauma
Treatment for anxiety disorders
• Biological– Antianxiety drugs– Antidepressant drugs– D-Cycloserine
• Cognitive– Cognitive-behavior therapy
• Behavioral– Exposure therapy– Systematic desensitization
Mood disorders
• Disorders characterized by emotional extremes– Major depressive disorder– Bipolar disorder
Major Depressive disorder
• Overwhelming sadness, hopelessness and loss of interest– Symptoms
• Emotional• Cognitive• Motivational• Somatic
– Symptoms last 2+ weeks– Prevalence
Treating Depression
• Albert Ellis – Cognitive Therapy– Confronting Irrational Thinking
• Beck – Cognitive Behavioral Therapy– Socratic Dialogue– Thought Records
• Event – Feelings – Cognitions – Other interpretations– Cognitive Restructuring– Collaborative Empiricism
• Behavioral Homework Assignments• Scheduling Activities (Mastery, Pleasure, Tests)
• Jacobson – Behavioral Activation– Increase opportunities for reinforcement
Bipolar disorder
• Characterized by wide swings between two emotional extremes– Mania
– Depression
• Cyclic switching between moods• Treatment – Lithium and behavioral
therapies
Treatment for mood disorders
• Biological– Antidepressants (depression)– Mood stabilizers (bipolar)– Electroconvulsive therapy (depression)– Deep-brain stimulation (depression)– Transcranial magnetic stimulation
(depression)
• Psychotherapy– Cognitive-behavioral therapy– Psychodynamic/Interpersonal therapy
Personality disorders
• Maladaptive behaviors which impair social functioning– Antisocial personality disorder– Borderline personality disorder
Antisocial personality disorder
• Marked by a lack of conscience and malicious behavior patterns– Symptoms
– Prevalence• Low in ______________ population,
high in _______________ populations
Antisocial personality disorder
• Associated with reduced cortical volume and activation of the frontal cortex
• Also associated with low levels of stress hormones and arousal
Borderline personality disorder
• Unstable personality, mood, identity and behavior– Symptoms
• Emotional instability• Impulsivity• Unstable identity• Fear of abandonment• Paranoid ideation
– Prevalence• 3:1 Females:Males
Treating BPD
• Linehan - Dialectical Behavior Therapy– Individual Therapy
• Acceptance-Change dialectic
– Group Skills Training• Emotion Regulation• Distress Tolerance• Interpersonal Effectiveness• Mindfulness
– Therapist Consult Team– 24 Hour Phone Consultation
Schizophrenia
• Split from reality– Disorganization of thought, perceptions,
emotions and behaviors– Prevalence
Schizophrenia
• Symptoms– Positive
• Thought disorder• Hallucinations• Delusions
– Negative• Flat affect• Lack of motivation• Decline in communication and interaction
Schizophrenia
• Dopamine hypothesis - excess of DA causes positive symptoms
• Prenatal factors– Virus– Stress
• Environmental or developmental factor influences onset
Treatment for Schizophrenia
• Biological– Antipsychotic drugs
• Reduce dopamine• Long-term consequences
• Behavioral– Operant conditioning
• Token economy