Abnormal Psychology and Therapy

1. im green with envy Abnormal Psychology and Therapy Amy Miller, Cassie Joseph, Catherine Hildebrand, Kenny Nguyen, Lauren Latimer つ ◕◡◕ ༽つ ლ(ಠ益ಠლ)

2. Hildebrand: Abnormal Behavior • Only one of three criteria needs to be present for the behavior to be considered abnormal • The context of the behavior can help determine if the behavior is abnormal • Behavior that is deviant, maladaptive, or personally distressful over a relatively long period of time

3. Biological approach • medical model- the view that psychological disorders are medical diseases with a biological origin (includes mental illness, patient, and doctor) • psychological disorders come from organic, internal causes and focuses on the brain, genetic factors, and neurotransmitter functioning

4. Sociocultural approach • gender • ethnicity • socioeconomic status • family relationships • culture • cultures influence the understanding of disorders and some are culture specific

5. Biopsychosocial approach • Abnormal behavior is influenced by biological factors (genes), psychological factors (childhood experiences), and sociocultural factors (gender) and these aspects usually work together. • There are many interacting factors that come from different experiences • no factor is more important than others

6. Classifying abnormal behavior • provides common basis for communication Helps clinicians make predictions about: • how likely it is that a particular disorder will occur • which individuals are susceptible to it • how the disorder progresses • what the outcome of the treatment is • providing a name for the disorder can create comfort or a stigma

7. The DSM-IV classification system *We are currently using the DSM-V as of last May • The Diagnostic and Statistical Manual of Mental Disorders • classifies individuals on 5 levels: • Axis I: All diagnostic categories excpet personality disorders and mental retardation • Axis II: Personality disorders and mental retardation • Axis III: General medical conditions • Axis IV: Psychosocial and environmental problems • Axis V: Current level of functioning

8. Critiques of DSM-IV • the manual classifies individuals based on their symptoms, using medical terminology and thinking about medical disorders as internal problems • pathology- emphasize strengths instead of just weaknesses

9. Major Categories of Psychological Disorders Axis I Disorders

11. Therapy • Therapy is a widespread use of relieving psychological suffering • There are many different forms of therapy including Drug therapy, Electroconclusive therapy, and Psychosurgery therapy

12. Drug Therapy Antianxiety Drugs: • Makes individual calmer and less excitable • Most common of these drugs are Xanax, Valium, and Librium • Can be very addicting because they work by binding to the receptor sites of neurotransmitters that become overactive during anxiety. • Side effects are drowsiness, loss of coordination, fatigue, and mental slowing • These drugs are so widely used because many individuals need help coping with stress and anxiety. It’s best used only temporarily for symptomatic relief.

13. Drug Therapy Cont. Antidepressant Drugs: • Four main classes of these drugs are tricyclics, such as Elavil; tetracyclics such as Avanza: monoamine oxidase inhibitors, such as Nardil; and selective serotonin reuptake inhibitors such as Prozac • Tricyclics are believed to work by increasing the levels of certain neurotransmitters. reduce symptoms of depression by 60 to 70 percent. may take 2 to 4 weeks to see improvement. • Tetracyclic s have effects on both norepinephrine and serotonin, enhancing brain levels. According to recent analysis Remeron (tetracyclic) • was more effective in reducing depression than any other drug.

14. Drug Therapy Cont. Antidepressents: • MAO inhibitors block the enzyme monoamine oxidase. This enzyme breaks down neurotransmitters serotonin and norepinephrine in the brain. Scientists believe that blocking the action of MAO inhibitors allow these neurotransmitters to stick around in the brain’s synapses and help regulate mood. • Selective serotonin

15. ANXIETY • An unpleasant feeling of fear and dread • Normal Anxiety • Make-or-break exams • Big presentations • Seeing police lights flashing behind your car • Individuals with high levels of anxiety worry a lot • However, their anxiety doesn’t necessarily impair their ability to function Anxiety Disorders- Psychological disorders involving fears that are uncontrollable, disproportionate, to the actual danger the person might be in, and disruptive of ordinary life General Symptoms: • Motor tension (ie. jumpiness or trembling) • Hyperactivity (ie. dizziness or a racing heart) • Apprehensive expectations and thoughts

16. Are Psychological Disorders a Myth? “Mental illnesses are real medical conditions that affect millions of Americans” (NAMI/APA/NMHA, 2005) • Controversy for long time • Tom Cruise vs. Brooke Shields • ADHD Debate • Attention Deficit Hyperactivity Disorder-is a behavioral condition that makes focusing on everyday requests and routines challenging (APA definition) • National Institute of Mental Health- conference that led to 75 psychiatrist and psychologists to declare that ADHD is a real psychological disorder with a biological basis in the brain

17. Are Psychological Disorders a Myth? Prevalence in Today’s society: • Media is incorporating more of these disorders into the news to spread around information • Cinema: • Iron Man 3- Tony Stark has PTSD and suffers from anxiety/panic attacks • Silver Linings Playbook- Pat Solitano, Jr. (Cooper) has bipolar disorder • The King’s Speech- King George VI has glossophobia (fear of public speaking)

18. Generalized Anxiety Disorder (GAD) Generalized Anxiety Disorder (GAD)- Psychological disorder marked by persistent anxiety for at least six months and in which the individual is unable to specify the reasons for the anxiety. • Nervous most of the time • Worry about work, relationships, or health • Suffer from: • Fatigue • Muscle tension • Stomach problems • Insomnia • Etiology (Cause ) • Genetic predisposition • Deficiency in the neurotransmitter GABA • Sympathetic nervous system activity • Respiratory System abnormalities • Harsh self-standards • Overly strict and critical parents • Negative thoughts • History of uncontrollable traumas or stressors

19. Generalized Anxiety Disorder (GAD) Symptoms: • Constant worrying or obsession about small or large concerns • Restlessness and feeling keyed up or on edge • Fatigue • Difficulty concentrating or your mind "going blank" • Irritability • Muscle tension or muscle aches • Trembling, feeling twitchy or being easily startled • Trouble sleeping • Sweating, nausea or diarrhea • Shortness of breath or rapid heartbeat Treatments: • Medication • Antidepressants • Buspirone • Benzodiazepines • Psychotherapy

20. Generalized Anxiety Disorder (GAD) Nancy L., a 45-year-old married lawyer, presented with exacerbation of her chronic generalized anxiety and recurrent depressive symptoms in January 2005. Nancy had a history of anxiety dating back "as far as I can remember." She was an anxious young girl with separation anxiety and shyness that manifested in elementary school. She remembers marked fears, including fears of the dark and thunder, most of which she "outgrew" except for a persistent fear of insects, particularly spiders. Her anxiety became more prominent and persistent after she left home at age 18 and entered college. She sought care at the university health service and received a prescription for diazepam that she used over the next 4 years on an as-needed basis during periods of increased anxiety such as examinations; she also met episodically with a therapist at the counseling center. In the spring of her freshman year, she experienced her first major depressive episode following a break-up with a boyfriend. She was prescribed imipramine, which she took for a couple of months but then discontinued because of intolerable side effects (dry mouth and lightheadedness). The depression gradually resolved over the next 6 months. Nancy continued to be plagued by persistent feelings of anxiety and worry associated with insomnia, irritability, tension, and fatigue. Over the years, her friends and family chided her for "worrying too much," and she reported difficulty controlling her anxiety over her financial situation, job security, and her children's safety, despite evidence that none of these were problematic. Her husband reported that he found her persistent anxiety and ongoing need for reassurance "exhausting" and that he noticed himself withdrawing from her, which led to significant tension between them. In addition, over the last 25 years, she has had 5 or 6 episodes of major depression lasting from 3 to 4 months to over a year. These episodes have sometimes, but not always, been triggered by situational stressors; one occurred during a postpartum period.

21. Panic Disorder Panic Disorder- Anxiety disorder in which the individual experiences recurrent, sudden onsets of intense apprehension or terror, often without warning and with no specific cause Etiology • Biological Factors • Genetic disposition: May have an automatic nervous system that is predisposed to be overly active • Problems with norepinephrine and GABA • Psychological Factors • Misinterpret harmless indicators of physiological arousal as an emergency • Controversial • Slightly raised heart rate→ Heart Attack • Sociocultural Factors • American women are twice as likely as American men to have panic attacks • Possible reasons: biological differences in hormones and neurotransmitters • Women cope differently than men in these situations • Possibly explains gender differences in panic disorders

22. Panic Disorder Symptoms: • Severe palpitations • Extreme shortness of breath • Chest pains • Trembling • Sweating • Dizziness • Feeling of helplessness • Nausea • Chills • Hot Flashes Possible could feel like they’re having a heart attack Treatments: • Psychotherapy • Medication • Selective serotonin reuptake inhibitors (SSRIs) • Serotonin and norepinephrine reuptake inhibitors (SNRIs) • Benzodiazepines

23. Panic Disorder “My name is Colin Hammond…I had my first panic attack in 1982. My wife Marion and I were driving home one evening from Birmingham to London and I got stuck in Coventry. Marion managed to get me to the local police station who summoned an ambulance and I was rushed into the local hospital, blue lights flashing and everything…and after various medical tests, they diagnosed that I’d had my first major panic attack. The whole illness that I suffered could be classed very simply as panic attacks which led to agoraphobia and monophobia, which totally devastated my life, my partner’s life, and we lost all our friends and became hermits. There is a popular misconception that agoraphobia is a fear of open spaces. It’s not strictly true, it does encompass that, but it also means being anywhere where you don’t feel safe, or where you feel trapped, where you haven’t got a quick exit, quick way home. So I developed monophobia at the same time, which was a fear of being on my own or without Marion. So consequently Marion couldn’t go out and about either. So we were virtually stuck in the house and Marion became a prisoner of my fear. It took me 18 months to see a properly qualified cognitive behavioural therapist who understood my illness and knew the way forward for me. And so over a period of two and a half years, with his help and support, I managed to break down the barriers and we got a reasonable semblance of our life back. We were able to travel around, go and do various bits and pieces, even back on to motorways and things…so…I think people have to understand that the therapist doesn’t do anything to you. He gives you the tools to paint the picture and you use those tools to make your recovery. After about six months, as I started to recover, we thought, “I can’t go out to work for a while. Let’s see if we can help a few people understand and overcome anxiety and panic and phobias in the way that my CBT therapist had helped me to do it.” And so we put a little advert in a local paper and we had about four replies and No Panic was born. One of our main ideas was to start local self-help groups. But we soon realised that if a person can’t get out, how are they going to get to a support group in the first place? So we’ve tended to veer away from that and we offer recovery groups by telephone where people who are perhaps trapped in their home, perhaps through their agoraphobia or another anxiety illness, can still get help without having to travel any distance to get that help. I think the feeling that you’re helping someone else is the best feeling in the world.”

24. Panic Disorder You’re not alone: • Charles Darwin suffered from intense panic disorder • Actor Kim Basinger and NFL running back Earl Campbell also have dealt with the order • Princess Diana • David Bowie • Oprah Winfrey • Johnny Depp • Scarlett Johansson • Sigmund Freud • Nikola Tesla • Adele And the list doesn’t end there!

25. Phobia Disorder Phobia Disorder- Anxiety disorder characterized by an individual, overwhelming, persistent fear of a particular object or situation • Different from GAD in the sense that individuals with phobias know exactly what they are afraid of • A fear becomes a phobia when a situation is so dreaded that an individual goes to almost any length to avoid it • Uncontrollable, disproportionate, and disruptive • Usually begin in childhood • Come in many different forms • Etiology • Genetic Disposition- neural circuit (includes thalamus, amygdala, and cerebral cortex) • Neurotransmitters • Learned fears- experience or others experiences

26. Phobia Disorder

27. Phobia Disorder Symptoms: • A feeling of uncontrollable panic, terror or dread when you're exposed to the source of your fear • The feeling that you must do everything possible to avoid what you fear • The inability to function normally because of your anxiety • Physical as well as psychological reactions, including sweating, rapid heartbeat, difficulty breathing, a feeling of panic and intense anxiety • Often, the knowledge that your fears are unreasonable or exaggerated but feeling powerless to control them Treatments: • Medications • Beta blockers • Antidepressants • Sedatives • Psychotherapy • Desensitization/Exposure Therapy • Cognitive Behavioral Therapy

28. Phobia Disorder

29. Obsessive Compulsive Disorder (OCD) Obsessive Compulsive Disorder (OCD)- Anxiety disorder in which the individual has anxiety- provoking thoughts that will not go away and/or urges to perform repetitive, ritualistic behaviors, to prevent or produce some future situation • Obsessions- recurrent thoughts • Compulsions- recurrent behaviors • Dwell on normal doubts and repeat their routines sometimes hundreds of times a day Most Common: • Excessive checking, cleansing, and counting Most individuals do not enjoy their ritualistic behavior but feel extraordinarily anxious when they do not carry it out

30. Obsessive Compulsive Disorder (OCD) Etiology: • Biological Factors • Genetic component • Biological links- the frontal cortex or basal ganglia are so active in OCD that numerous impulses reach the thalamus→ Obsessive thoughts or compulsive actions • Psychological Factors • Occurs in a period of life stress (ie. birth of child or change in occupation or marital status) • Cognitive Perspective • OCD vs. No OCD= the ability (or inability) to turn off negative, intrusive thoughts by ignoring or effectively dismissing them

31. Treatments: Psychotherapy Medication Clomipramine (Anafranil) Fluvoxamine (Luvox CR) Sertraline (Zoloft) Paroxetine (Paxil, Pexeva) Obsessive Compulsive Disorder (OCD) Obsession Symptoms: • Fear of contamination or dirt • Having things orderly and symmetrical • Aggressive or horrific thoughts about harming yourself or others • Unwanted thoughts, including aggression, or sexual or religious subjects Compulsion Symptoms: • Washing and Cleaning • Counting • Checking • Demanding reassurances • Following a strict routine • Orderliness

32. Obsessive Compulsive Disorder (OCD)

33. Post-Traumatic Stress Disorder (PTSD) Post-Traumatic Stress Disorder (PTSD)- Anxiety disorder that develops through exposure to a traumatic event that has overwhelmed the person’s abilities to cope • Ranges from minor car accident to traumatic war event or even rape • Symptoms can be present immediately following the event or even months or years after • Not everyone experiences the same symptoms • ie. Victim of a vehicular accident vs. War Veteran • Associated with a variety of different experiences • Combat and war-related trauma • Sexual abuse and assault • Natural disasters (earthquake or hurricane) • Unnatural disasters (plane crash or terrorist attack) • Contributing Factors- Vulnerability • History of previous traumatic events and conditions (abuse) • Previous Psychological disorders • Genetic predisposition

34. Post-Traumatic Stress Disorder (PTSD) Symptoms: • Flashbacks • Bad Dreams • Avoidance • Feeling emotionally numb • Strong guilt, depression, or worry • Losing interest in hobbies • Repression of event • Easily startled • Tense or “on edge” • Insomnia Treatments: • Psychotherapy (“talk therapy”) • Exposure therapy • Medication- antidepressants • sertraline (Zoloft) • paroxetine (Paxil)

35. Post-Traumatic Stress Disorder (PTSD)

36. My References http://www.nimh.nih.gov/health/topics/post-traumatic-stress-disorder-ptsd/index.shtml#part6 http://www.therapyforyou.co.uk/About-Therapy-For-You/Case-Studies/Panic-Disorder.aspx http://www.medscape.org/viewarticle/527758_4 http://www.mayoclinic.org/diseases-conditions/panic-attacks/basics/treatment/con-20020825 The book! http://www.mayoclinic.org/diseases-conditions/phobias/basics/symptoms/con-20023478 http://www.mayoclinic.org/diseases-conditions/ocd/basics/symptoms/con-20027827

37. Nguyen: Mood Disorders • Mood disorders are psychological disorders in which there is a primary disturbance of mood • Include cognitive, behavioral, and somatic symptoms • In addition to the common disorders, also includes: • Substance-induced disorders • Benzodiazepine-induced mood disorder • General medical condition • Alzheimer’s • Not otherwise specified • Random disorder that does not fit in with any category • Mixed-anxiety depressive disorder • Controversy on the origin of mood disorders • Evolutionary adaptation

38. Depressive Disorders • Depressive disorders are where the individual suffers from depression • An unrelenting lack of pleasure in life • High risk of suicide • Major depressive disorder involves a significant depressive episode and depressed characteristics • Lasts about two weeks or longer • Impairs daily functioning • Fatigue or loss of energy, trouble sleeping, thoughts of suicide • Dysthymic disorder is generally more chronic and has fewer symptoms than MDD • Individual is in a depressed mood for most days in at least two years • Sleep problems, low self-esteem, hopelessness

39. Factors • Biological Factors: • Genetics play a role in depression • Depressed individuals show lower levels of brain activity in a section of the prefrontal cortex • Depression likely involves problems in the body’s regulation of a number of neurotransmitters • Psychological Factors: • Prolonged stress, feeling of powerlessness • Depression related to pessimistic attributional style, attempts to explain what caused something to happen • Sociocultural Factors: • Living in low socioeconomic status • Women twice as more likely (single, head of house, etc.)

40. Depression among Men and Women across Cultures • In all countries, rate of depression among females almost doubles that of males • Not only are women more prone to depression than men, their symptoms and causes are even more ambiguous • Probable cause from plethora of reproductive hormones to gender role stress • Evolutionary coffeecauses? “Coffee, it’s a man’s drink.”

41. Depressed Children • For most children, early childhood is enjoyable • Napping, cartoons, playing, eating • Childhood depression rate ranges from 1.5% - 2.5% • Lack of playfulness, tantrums, tummy aches :( • Usually angry rather than sad • “At least 50% of children and adolescents with depression have another psychological disorder…. such as eating disorders or drug addictions.” —Harvard Medical School • And 50% of children with a parent that has depression will show depression at least once before the age of 20 • After many years of research, a direct cause is still not known. Though major traumatic events might be one

42. Depression

43. Bipolar Disorders • Bipolar disorder is characterized by abnormal, persistent cycles of high mania to depression • Severe symptoms that can result in damaged relationships, poor job and school performance, etc . • Bipolar I is distinguished by many manic episodes without major depressive ones (i.e., hallucinations) • Bipolar II is milder, distinguished by less extreme mania • Quite difficult to diagnose • Cyclothymia consists of both recurrent mania and depression, but neither extreme

44. Suicide • Suicide is not a diagnosable disorder • A tragic consequence of psychological disorders, commonly depression and anxiety • Common in depression • Suicide is the 11th highest cause of death • Third leading cause of death for teenagers • For every successful suicide, there are eight attempted ones

45. Factors • Biological Factors: • Suicide tends to run in families • Studies linked suicide with low levels of serotonin (10x more likely to attempt suicide with low levels) • ****Five members of the Hemingway family committed suicide, including the writer himself • Psychological Factors: • Mental disorders and traumas, such as sexual abuse • Struggling with stress, leaving a person feeling hopeless • Most commonly: the loss of a loved one • Sociocultural Factors: • Chronic economic hardship • No surprise, lowest suicide rates in countries where religion prevents it

46. Case Study The notorious Suicide Forestin Yamanashi, Japan • A forest (Aokigahara) that lies at the base of Mount Fuji • People commonly go inside alone, with tents and camp for a few days • Contemplate their life • In 2010, over 105 bodies were found in the forest • 254 attempted to commit the act • 4th in suicide list locations • Subways also a common location in Japan • Over 100 suicides a year • Obviously, Japan has one of the highest suicide rates in the world

47. Schizophrenia • Schizophrenia is a chronic, severe, and disabling brain disorder • Schizophrenia causes significant social and work problem; about 0.3–0.7% of people are affected during their lifetime • Mainly affects the ability to think, but also contributes to chronic problems with behavior and emotion. Schizophrenics are likely to have additional condition (major depression, anxiety disorders etc.)

48. Symptoms Positive symptoms • Paranoia; hearing voices or noises that are not there; disorganized thinking; a lack of emotion and a lack of motivation • assigning unusual significance or meaning to normal events or holding fixed false personal beliefs (delusions) Negative symptoms • onset of depression, impaired thinking, introversion and personal neglect • assigning unusual significance or meaning to normal events or holding fixed false personal beliefs (delusions)

49. Causes Genetic • Individuals with a first-degree relative (parent or sibling) who has schizophrenia have a 10 percent chance of developing the disorder, as opposed to the 1 percent chance of the general population. • 60% of schizophrenics have no family members with the disorder Environmental • environmental factors trigger the disorder in those with the genetic predisposition • High levels of stress increase the body’s production of cortisol. • Prenatal or infant exposure to an infection • Low oxygen levels during birth (from prolonged labor or premature birth) • Loss of parent or sexual abuse Brain Structure • Enlarged brain ventricles (Cavities filled with cerebrospinal fluid)are seen in some schizophrenics, which result in a lower overall volume of brain tissue • abnormalities in the temporal lobes, hippocampus, and amygdala are connected to schizophrenia’s

50. Treatment Cognitive behavioral therapy • focuses on thinking and behavior; helps patients with symptoms that do not go away even when they take medication • teaches people how to test the reality of their thoughts and perceptions, how to "not listen" to their voices, and how to manage their symptoms overall Psychosocial treatments • help these patients deal with the everyday challenges of the illness, such as difficulty with communication, self-care, work, and forming and keeping relationships • Learning and using coping mechanisms to address these problems allow people with schizophrenia to socialize and attend school and work. Rehabilitation • social and vocational training to help people with schizophrenia function better in their communities. • include job counseling and training, money management counseling, help in learning to use public transportation, and opportunities to practice communication skills