Table of Contents Exit Chapter 18 Major Mental Disorders

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Chapter 18Chapter 18Major Mental DisordersMajor Mental Disorders


Key Questions What are the general characteristics of psychosis?

How do delusional disorders differ from other forms of psychosis?

What forms does schizophrenia take?

What causes schizophrenia?

What are mood disorders? What causes depression?

How are major mental disorders treated?

Who do people commit suicide? Can suicide be prevented?

What does it mean to be “crazy”? What should be done about it?


Psychosis- “Losing It” Page 584


Psychosis and Hallucinations Psychosis:

Loss of contact with shared views of reality

Hallucinations: Imaginary sensations, such as seeing, hearing,

or smelling things that do not exist in the real world Most common psychotic hallucination is hearing

voices

Note that olfactory hallucinations sometimes occur with seizure disorder (epilepsy)


Psychosis and Hallucinations

Delusions: False beliefs that individuals insist are true,

regardless of overwhelming evidence against them

1. Depressive

2. Somatic

3. Grandeur

4. Influence

5. Persecution

6. Reference


Some More Psychotic Symptoms

Flat Affect: Lack of emotional responsiveness; face is frozen in

blank expression

Disturbed Verbal Communication: Garbled and chaotic speech; word salad

Personality Disintegration: When an individual’s thoughts, actions, and

emotions are uncoordinated

Brief Reactive Psychosis: Psychotic symptoms typically appear after an

extremely stressful event


Table 18-1 Common Warning Signs of Psychosis and Major

Mood Disorders Expresses bizarre thoughts or beliefs that defy reality

Has withdrawn from family members and other relationships

Hears unreal voices, sees things others don’t

Is extremely sad, persistently despondent, or suicidal

Is excessively energetic, has little need for sleep

Loses appetite, sleeps excessively, has no energy

Exhibits extreme mood swings

Believes someone is trying to harm her or him

Has engaged in anti-social, destructive, or self-destructive behavior


Other Psychotic Disorders

Organic Psychosis: Psychosis caused by brain injury (gunshot

wound) or disease

Functional psychosis Based on unknown causes or psychological

factors


Organic Psychosis Dementia:

Most common organic psychosis; serious mental impairment in old age caused by brain deterioration

Archaically known as senility (senile dementia)

Alzheimer’s Disease: Symptoms include impaired memory, confusion,

and progressive loss of mental abilities

Ronald Reagan most famous Alzheimer’s victim

(Page 587)


Organic PsychosisCinema Education

The Notebook

A Moment to Remember (Subtitled)


Delusional Disorders Delusional Disorders:

Marked by presence of deeply held false beliefs (delusions)

May involve delusions of grandeur, persecution, jealousy, or somatic delusions

Experiences could really occur!

Paranoid Psychosis: Most common delusional disorder

Centers on delusions of persecution


Schizophrenia: The Most Severe Mental

Illness Schizophrenia: Psychotic disorder characterized by

hallucinations, delusions, apathy, thinking abnormalities, and “split” between thoughts and emotions

Does NOT refer to having split or multiple personalities


The Four Subtypes of Schizophrenia

Disorganized (Hebephrenic) Type: Incoherence, grossly disorganized behavior, bizarre thinking, and flat or inappropriate emotions

Catatonic Type: Marked by stupor, unresponsiveness, posturing, and mutism

Paranoid Type: Preoccupation with delusions; also involves auditory hallucinations that are related to a single theme, especially grandeur or persecution

Undifferentiated Type: Any type of schizophrenia that does not have specific paranoid, catatonic, or disorganized features or symptoms


Fig. 16.6 Over a period of years, Theodore Kaczynski mailed bombs to unsuspecting victims, many of whom were maimed or killed. As a young adult, Kaczynski was a brilliant mathematician. At the time of his arrest, he had become the Unabomber—a reclusive “loner” who deeply mistrusted other people and modern technology. After his arrest, Kaczynski was judged to be suffering from paranoid schizophrenia.

© Bruce Ely/Getty Images


Causes of Schizophrenia

Environment Psychological Trauma:

Psychological injury or shock, often caused by violence, abuse, or neglect

Disturbed Family Environment:

Stressful or unhealthy family relationships, communication patterns, and emotional atmosphere

Deviant Communication Patterns:

Cause guilt, anxiety, anger, confusion, and turmoil

Double-bind communication:

Places the listener in an unsolvable emotional conflict, or “no-win” situation


Causes of Schizophrenia

Heredity Some individual inherit a potential for

developing schizophrenia

They are more vulnerable to the disorder than others are

EX: If 1 identical twin becomes schizophrenic (identical twins have identical genes) then the other twin has a 48% chance of also becoming schizophrenic


Research Classic The Genain Sisters- Trouble times four (page

592)


Fig. 16.7 Lifetime risk of developing schizophrenia is associated with how closely a person is genetically related to a schizophrenic person. A shared environment also increases the risk. (Estimates from Lenzenweger & Gottesman, 1994.)


Biochemical Causes of Schizophrenia

Biochemical Abnormality: Disturbance in brain’s chemical systems or in

the brain’s neurotransmitters

Dopamine: Neurotransmitter involved with emotions and

muscle movement

Works in limbic system

Dopamine overactivity in brain may be related to schizophrenia


Fig. 18.3 Dopamine normally crosses the synapse between two neurons, activating the second cell. Antipsychotic drugs bind to the same receptor sites as dopamine does, blocking its action. In people suffering from schizophrenia, a reduction in dopamine activity can quiet a person’s agitation and psychotic symptoms.


Louis WainThis series of paintings by Louis

Wain reflects a troubled personality. Wain was a British illustrator who became schizophrenic in middle

age. As Wain’s psychosis progressed, his cat paintings became highly abstract and

fragmented. In many ways, Wain’s paintings resemble the perceptual

changes caused by psychdelic drugs such as LSD. Recent research

suggests that psychosis may, in fact, be the result of mind-altering

changes in brain chemistry


Schizophrenic Brain Computed Tomography (CT) Scan:

Computer enhanced X-ray of brain or body

Magnetic Resonance Imaging (MRI) Scan: Computer enhanced three-dimensional image of brain

or body; based on magnetic field MRIs show schizophrenic brains as having enlarged ventricles

Positron Emission Tomography (PET) Scan: Computer-generated color image of brain activity;

radioactive sugar solution is injected into a vein, eventually reaching the brain Activity is abnormally low in frontal lobes of schizophrenics


Fig. 18.4 (left) CT scan of would-be presidential assassin John Hinkley, Jr., taken when he was 25. The X-ray image shows widened fissures in the wrinkled surface of Hinkley’s brain. (right) CT scan of a normal 25-year-old’s brain. In most young adults the surface folds of the brain are pressed together too tightly to be seen. As a person ages, surface folds of the brain normally become more visible. Pronounced brain fissuring in young adults may be a sign of schizophrenia, chronic alcoholism, or other problems.

© Dennis Brack/Stockphoto.com76


Fig. 18.5 Positron emission tomography produces PET scans of the human brain. In the scans shown here, red, pink, and orange indicate lower levels of brain activity; white and blue indicate higher activity levels. Notice that activity in the schizophrenic brain is quite low in the frontal lobes (top area of each scan) (Velakoulis & Pantelis, 1996). Activity in the manic-depressive brain is low in the left brain hemisphere and high in the right brain hemisphere. The reverse is more often true of the schizophrenic brain. Researchers are trying to identify consistent patterns like these to aid diagnosis of mental disorders.


Schizophrenia Beautiful Mind


Stress-Vulnerability Model

Stress-Vulnerability Hypothesis: Combination of environmental stress and

inherited susceptibility cause schizophrenic disorders


Fig. 18.6 Various combinations of vulnerability and stress may produce psychological problems. The top bar shows low vulnerability and low stress. The result? No problem. The same is true of the next bar down, where low vulnerability is combined with moderate stress. Even high vulnerability (third bar) may not lead to problems if stress levels remain low. However, when high vulnerability combines with moderate or high stress (bottom two bars) the person “crosses the line” and suffers from psychopathology.


Mood Disorders Mood disorders:

Major disturbances in emotion, such as depression or mania

Depressive Disorders: Sadness or despondency are prolonged, exaggerated, or unreasonable

Bipolar Disorders: Involve both depression and mania or hypomania

Dysthymic Disorder: Moderate depression that lasts for at least two years

Cyclothymic Disorder: Moderate manic and depressive behavior that lasts for at least two

years

Reactive depression: Is an episode of despondency that follows some identifiable event


Major Mood Disorders Major mood disorders:

Lasting extremes of mood or emotion and sometimes with psychotic features (hallucinations, delusions)

Major Depressive Disorder: A mood disorder where the person has suffered one or more

intense episodes of depression; one of the more serious mood disorders

Bipolar I Disorder: Extreme mania and deep depression; one type of manic-depressive

illness Mania: Excited, hyperactive, energetic, grandiose behavior

Bipolar II Disorder: Person is mainly sad but has one or more hypomanic episodes (mild

mania)

Affective psychosis: Combination of mood disorder and a break with reality


Major Mood Disorders (cont.)

Endogenous Depression: Depression that seems to be produced

from inside the body (due to chemical imbalances) and NOT from life events

Seasonal Affective Disorder (SAD): Depression that only occurs during fall

and winter May be related to reduced exposure to sunlight

Phototherapy: Extended exposure to bright light to treat SAD


Batman and his Foes

Comic Book characters and their problems


Feeling Sad? It Could Be SAD

Page 598


Fig. 18.7 Seasonal affective disorder appears to be related to reduced exposure to daylight during the winter. SAD affects 1 to 2 percent of Florida’s population, about 6 percent of the people living in Maryland and New York City, and nearly 10 percent of the residents of New Hampshire and Alaska (Booker & Hellekson, 1992).


Fig. 18.8 An hour or more of bright light a day can dramatically reduce the symptoms of seasonal affective disorder. Treatment is usually necessary from fall through spring. Light therapy typically works best when it is used early in the morning (Lewy et al., 1998).

© Dan McCoy/Rainbow


Maternity Blues Maternity Blues:

Mild depression that lasts for one to two days after childbirth

Marked by crying, fitful sleep, tension, anger, and irritability

Brief and not too severe


Postpartum Depression

Postpartum Depression: Moderately severe depression that begins

within three months following childbirth

Marked by mood swings, despondency, feelings of inadequacy, and an inability to cope with the new baby

May last from two months to one year

Part of the problem may be hormonal


Fig. 18.9 At least one schizophrenic patient in four had completely recovered 10 years after being diagnosed. Three out of four had improved. New treatments for schizophrenia and other major mental disorders may improve these odds. (Source: FDA Consumer, 1993.)


Therapeutic Interventions Psychotherapy:

Any psychological treatment for behavioral or emotional problems

Typically involves two people talking about one’s personal problems

Somatic Therapies: Bodily

Drug therapy, hospitalization, or psychosurgery

Pharmacotherapy: Use of drugs to alleviate the symptoms of

emotional disturbance


Pharmacotherapy What type of drugs are used in

pharmacotherapy? Tranquilizers

Drugs (Valium) that produce relaxation or reduce anxiety

Antidepressants

Are mood elevating drugs used to combat depression

Antipsychotics

Drugs that, in addition to having tranquilizing effects, also tend to reduce hallucinations and delusional thinking.


Psychiatric “Wonder Drugs”

Read page 601


Shock Electroconvulsive Therapy (ECT)

A 150-volt electrical current is passed through the brain for slightly less than a second

How does shock help? It is the seizure that helps, which is induced by

the shock


Psychotherapy Psychotherapy

Any surgical alteration of the brain

Best known psychotherapy

Prefrontal lobotomy: The frontal lobes are surgically disconnected from the other areas of the brain

Deep lesioning: Small target areas are destroyed in the brain’s interior


Suicide: Major Risk Factors

Drug or alcohol abuse

Prior suicide attempt

Depression or other mood disorder

Availability of a firearm

Severe anxiety or panic attacks

Family history of suicidal behavior

Shame, humiliation, failure or rejection


Fig. 18.10 Adolescent suicide rates vary for different racial and ethnic groups. Higher rates occur among whites than among non-whites. White male adolescents run the highest risk of suicide. Considering gender alone, it is apparent that more male than female adolescents commit suicide. This is the same as the pattern observed for adults.


Common Characteristics of Suicidal Thoughts and Feelings

(Page 605) Escape

Unbearable Psychological Pain: Emotional pain that the person wishes to escape

Frustrated Psychological Needs: Such as searching for love, achievement, or security

Constriction of Options: Feeling helpless and hopeless and deciding that death is the only option left


Fig. 16.16 Suicidal behavior usually progresses from suicidal thoughts, to threats, to attempts. A person is unlikely to make an attempt without first making threats. Thus, suicide threats should be taken seriously (Garland & Zigler, 1993).

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Table of Contents Exit Chapter 18 Major Mental Disorders