Modules 29, 30, & 31 Mental Disorders

1. Modules 29, 30, & 31 Mental Disorders

2. Causes of Mental Disorders – Diathesis-Stress Model of Mental Illness: • a. Low Predisposition – Low Stress -- No genetic history -- No out of the ordinary life events • b. High Predisposition – Low Stress -- Genetic history -- No out of the ordinary life events • c. Low Predisposition – High Stress -- No genetic history -- Out of the ordinary life events • d. High Predisposition – High Stress -- Genetic history -- Out of the ordinary life events • The causes of a mental disorder may be psychological, biological, sociocultural, or some combination of these three factors.

3. Bio-Psycho-Social Model

4. Bio-Psycho-Social Model • Biological-genes, brain, central nervous system, hormonal changes • Psychological-cognitions (thoughts), behavioral reactions • Sociocultural-societal expectations, environmental factors, learning/modeling

5. Insanity – A legal term used to describe a person who could not be held responsible for his or her actions due to mental illness. M’Naghten Rule (1843)* created the insanity defense * Scotsman who suffered from paranoid delusions killed the British prime minister’s secretary & was acquitted and sent to a mental hospital. In 1843 Daniel M'Naghten tried to kill England's prime minister Sir Robert Peel. At trial, M'Naghten was found not guilty by reason of insanity.HULTON-DEUTSCH COLLECTION

6. Durham Rule (1954) * Broadened insanity defense to include diagnostic labels (obsessive-compulsive disorder, multiple personality disorder, etc.) http://www.google.cm/imgres?q=Mental+illness&start=274&hl=fr&biw=1024&bih=571&gbv=2&tbm=isch&tbnid=utRPYWaeGSeLDM:&imgrefurl=http://

7. Insanity Defense Reform Act (1984) * Set into place after the attempt by John Hinckley, Jr. on President Reagan’s life in 1981. * Made it harder to use insanity defense. Hinckley developed a dangerous obsession with Foster, who played the 12-year-old child prostitute Iris/Easy in Taxi Driver. Just prior to Hinckley's failed attempt on Reagan's life, he wrote to Foster: "Over the past seven months I've left you dozens of poems, letters and love messages in the faint hope that you could develop an interest in me. Although we talked on the phone a couple of times I never had the nerve to simply approach you and introduce myself. [...] the reason I'm going ahead with this attempt now is because I cannot wait any longer to impress you." http://en.wikipedia.org/wiki/John_Hinckley,_Jr.

8. Myths concerning the mentally ill: 1. Easy to spot 2. Dangerous Definition of Abnormal Behavior: 1. Person suffers from discomfort more or less continuously 2. Person may behave in a bizarre fashion 3. Person who needs help may be inefficient 4. Person is typically inflexible 5. Person sees all aspects of life as threatening

9. Four D’s: Deviance, Distress, Dysfunction, and/or Danger • Deviance: behavior, thoughts, or emotions different from the norm in the time and place you live. • Distress: behavior, thoughts, or emotions that causes internal discomfort. • Dysfunction: social and/or economic problems, and/or ability to take care of oneself, inability to do a job, etc. • Danger: to oneself or others.

10. Does our society still attach a stigma to mental disorders? !!YES!!! – Unfortunately. Persons with schizophrenia are the most likely to be stigmatized as they meet most people’s definition of “crazy.” Nearly two-thirds of all people with diagnosable mental disorders do not seek treatment.--Surgeon General's Report on Mental Illness Charlie Sheen isn't funny (LA Times, March 12, 2011) It's easy to laugh at a grandiose addict taking his rant on the road, but troubled Charlie Sheen may have a mental illness and, if so, needs help.

11. Diagnostic and Statistical Manual of Mental Disorders IV Text Revision (DSM-IV-TR) • Book published by the American Psychiatric Association that classifies the symptoms of mental disorders into formal categories. • Use to diagnose mental illness via a medical model.

12. Category 1: Disorders of Childhood • ADHD • Autistic Spectrum Disorders • Autism • Asperger’s Disorder

13. Category 2: Anxiety Disorders • Panic • Phobic • OCD • PTSD • GAD

14. Category 3: Somatoform Disorders • Conversion Disorder (D/O) • Hypochondriasis • BDD

15. Category 4: Dissociative Disorders • Amnesia • Fugue • DID

16. Category 5: Mood Disorders • Dysthymic Disorder • Major Depressive Disorder • Mania • Bipolar Disorder

17. Category 6: Schizophrenia • Catatonic • Paranoid • Undifferentiated • Disorganized

18. Category 7: Personality Disorders • Antisocial • Borderline

19. Disorders of Childhood • I. Attention Deficit/Hyperactivity Disorder • 3 Types-Predominantly Hyperactive-Impulsive Type, • Predominately Inattentive Type, and Combined Type. • Disorder characterized by inattention, distractibility, • impulsiveness, and/or excessive activity, and restlessness. • Affects 8.4% of children ages 3-17–2x more boys diagnosed • than girls (Centers for Disease Control, 2011). • 20 % of children with ADHD have learning disabilities and • about 80 % have academic problems. • #1 reason for children to be referred to a mental health • professional. http://www.youtube.com/watch?v=z2hLa5kDRCA&feature=relmfu&safety_mode=true&persist_safety_mode=1

20. Theories on Causes of ADHD: • Most likely results from a variety of factors-no single • cause • 1. Genes • Some linked to thinner brain tissue development in areas • associated with attention-often improves as a person grows • older. • 2. Malfunction in prefrontal cortex of brain • Cause of malfunction not determined – further research • needs to be done. • 3. Environmental factors • Lead exposure • Brain injury • Toxins, like food additives-needs to be researched further. • Studies show no link with sugar consumption, even though • this is a popular idea.

21. Help for People with ADHD: • Drugs(Ritalin, Adderall, Concerta, • Dexadrine, Strattera, etc.) • Most common treatment (60%)/ highly effective • Stimulants (some amphetamines) • http://www.nimh.nih.gov/health/publications/attention-deficit-hyperactivity-disorder/complete-index.shtml • Side effects can be a problem • http://www.youtube.com/watch?v=FA4_mOfxKw0&feature=fvwrel&safety_mode=true&persist_safety_mode=1 • Environmental Structuring • Activities broken into short segments • Outside disruptions minimized • 3. Therapy

22. Detailed Example of Environmental Structuring: • Schedule. Keep the same routine every day, from wake-up time to bedtime. Include time for homework, outdoor play, and indoor activities. Keep the schedule on the refrigerator or on a bulletin board in the kitchen. Write changes on the schedule as far in advance as possible. • Organize everyday items. Have a place for everything, and keep everything in its place. This includes clothing, backpacks, and toys. • Use homework and notebook organizers.Use organizers for school material and supplies. Stress to your child the importance of writing down assignments and bringing home the necessary books. • Be clear and consistent.Children with ADHD need consistent rules they can understand and follow. • Give praise or rewards when rules are followed.Children with ADHD often receive and expect criticism. Look for good behavior, and praise it.

23. Other difficulties for people with ADHD: • Relationship issues - more likely to divorce. • Delinquent behavior - more likely to be incarcerated at some point in his/her life. 47% of youth in juvenile detention facilities have an ADHD diagnosis (NAMI, 2011). • Substance abuse – young adults have a 75% SAR if ADHD goes untreated (NAMI, 2011). • Employment problems – More likely to be fired.

24. Autistic Spectrum Disorders • Disorders characterized by a failure to develop normal patterns of communication, social interactions, and emotional responses. • Affects 6 in every 1,000 children – Males 4x more likely to be diagnosed (NIH, 2012).

25. Early indicators of the disorder: • no babbling or pointing by age 1 • no single words by 16 months or two-word phrases by age 2 • no response to name • loss of language or social skills • poor eye contact • excessive lining up of toys or objects • no smiling or social responsiveness http://www.youtube.com/watch?v=G7kHSOgauhg

26. Childhood symptoms: • Frequent tantrums • Rocking, spinning, or staring into space • Little pain sensitivity • Repeated head banging or flesh biting • Inability to maintain eye contact • Attachment to objects, not people • Reacting negatively to changes • Speech difficulties, like Echolalia – “echoing” or • repeating whathas just been said • http://www.youtube.com/watch?v=KqSGSMZfgNQ&feature=related ---Though very rare some individuals with autism display characteristics of Savant Syndrome – an unusual gift or ability in one area. http://www.youtube.com/watch?v=hKk96kOAnLg

27. High functioning individuals with normal to high I.Q.’s and mild symptoms sometimes diagnosed with Asperger’s Syndrome (sometimes referred to as the “Geek Syndrome”). Main Symptoms of Asperger’s Syndrome: 1. Motor delays 2. Clumsiness 3. Social interaction problems 4. Idiosyncratic (peculiar/strange) behavior Bill Gates

28. Theories/Myths on Causes of Autism: • No known cause as of yet-studies show super rapid brain growth during childhood. • Malfunctions in the middle and lower parts of the brain-corpus collusum undersized, amygdala & hippocampus enlarged, + other issues. • * Cause of malfunctions not determined – further research needs to be done. • 2. Genetics/Heredity • * Unclear link – may play a part in certain subtypes of autism. • 3. Cold, indifferent parents • * Myth • * Result of physiological or neurological problems, not bad parenting

29. Theories/Myths on Causes of Autism: • 4. Vaccines • * No scientific proof-many studies show no link. • * Signs of autism likely to be noticed • around the time the child is vaccinated. “…many moms and dads are convinced--despite mounting scientific evidence to the contrary--that the triple vaccine against measles, mumps and rubella (MMR) causes autism in some youngsters. The latest study exonerating the MMR vaccine comes from Denmark, where investigators looked at the health records of every child born from 1991 through '98, more than 537,000 children. No matter how researchers analyzed the data, there was no difference in the autism rates of children who received the MMR vaccine and those who did not” Read more: http://www.time.com/time/magazine/article/0,9171,1003673,00.html#ixzz1GlyDPlwO

30. Help for People with Autism: • No cure • Due to varying degrees of severity, no one treatment works in all cases. • Progress is usually limited to helping children care for themselves and control aggressive behavior (about 7% will wind up living on their own).

31. I'm in Here By Linda Yoccodine Gustoso My mind is like a puzzle, trying to make all the pieces fit,With so many things happening around me, it takes me more time to do my bit,I am smart, kind and have a beautiful face,But sometimes my mind needs just a little bit more space,It's like trying to fit huge furniture into a small room,And if there were smaller pieces, you would see that I would bloom,I wish you could be in my head just for one day, So you can hear what my heart really wants to say,I want you to know I am aware of many things, so please do not fear,Although my mind is like a puzzle, “I'm in here,”So thank you for your dedication and labor of love,You are angels for autism and blessed from up above!

32. Anxiety Disorders • Expect for substance abuse, the most common group of mental health disorders-impacts 1 out of every 10 people in US. • Anxiety-generalized feeling of apprehension and dread that includes many body upsets: • Sweaty palms/trembling hands • Erratic breathing/heart pounding • Restlessness/inability to calm down • Trouble sleeping/eating poorly Neurotic Paradox Anxiety Strange Behavior – relieves anxiety temporarily reinforcing/rewarding Individual knows that behavior is strange, others may notice as well – more anxiety created in long term

33. I. Panic Disorder • Disorder caused by frequent and overwhelming attacks of anxiety that are not associated with specific objects or events. • Symptoms include trouble breathing/hyperventilation, • feeling like one is having a heart attack or stroke, feelings of unreality and/or going “crazy”. • Drugs like Valium or Xanax (Benzodiazepines) can be helpful in treating panic disorder – psychotherapy is also effective.

34. Do you feel afraid???

35. II. Phobic Disorder • Disorder in which a person becomes • disabled and overwhelmed by fear in • the presence of certain objects or events. • 2 types: • A.Specific Phobia - phobic disorder associated with a specific object or situation, such as snakes, dogs, elevators, blood, etc. – most common phobias include things our ancestors feared. • Most likely the result of learning or association. • All of us have phobias, but true phobics live in mortal fear of being near the object. • True phobics can die if they are forced into a fearful situation. • http://www.youtube.com/watch?v=JDvDCqLCdEE • Start at 2:50

36. B. Agoraphobia • -fear of leaving a familiar environment, especially home – often accompanies panic d/o • May start in childhood or result from social isolation • Most agoraphobics have specific boundaries beyond which they will not go.

37. Anatomy of Panic Disorder and Agoraphobia inducing

38. II. Obsessive-Compulsive Disorder (OCD) • Disorder characterized by both repetitive thoughts (obsessions) and ritualized, repetitive behaviors (compulsions). • Impacts 2-3% of the population, though 14% shows minor symptoms. • Common Obsessions - endless preoccupation with certain thoughts or urges – • Aggressive Obsessions (fear of harming others or self) • Contamination Obsessions(concern with dirt/germs/body waste) • http://www.metacafe.com/watch/84755/true_life_living_with_ocd/ • Sexual Obsessions (forbidden sexual thoughts/images) • Somatic Obsessions(preoccupation w/ part of body-ears too long, etc.) • Misc. Obsessions(lucky/unlucky #’s, intrusive nonsense words, etc.)

39. Common Compulsions – repeated symbolic, ritualized behavior – • Counting Compulsions(having to do something a certain # of times-steps, flicking of light switch, etc.) • Checking Compulsions(checking doors, windows, locks, etc., over and over again) • Repeating Rituals(going in/out doors, up/down from chairs, etc.) • Ordering/Arranging Compulsions(Packing/unpacking, rearranging drawers, putting things in order by size and/or color) • Hoarding/Collecting Compulsions(Saving old newspapers, mail string, wrapping paper, etc.) • Misc. Compulsions (Need to tell, ask, or confess – need to touch and measure) • Compulsions temporarily relieve anxiety, so the behavior becomes self-rewarding and is repeated.

40. Hoarding currently is considered a type of OCD, but experts debate whether Hoarding quite fits under the OCD umbrella. • Some of the reasons that Hoarding OCD may not be true OCD include: • Unlike most people with OCD, the majority of hoarders do not want help. This fact also happens to make them much more difficult to treat. • Medication doesn’t work with Hoarding OCD nearly as well as it does for other types of OCD. • People with Hoarding OCD seem to have certain cognitive deficits (like the ability to categorize and make decisions) that are not shared by people with other types of OCD. • Hoarding OCD treatment typically takes much longer than other types of OCD treatment. • Hoarding OCD is more prone to relapse than other types of OCD. • http://www.youtube.com/watch?v=gQ-ZBvZrf1o&safety_mode=true&persist_safety_mode=1 • http://www.youtube.com/watch?v=iqVekHHObLg

41. Theories on the Causes of OCD • Faulty attempt to resolve guilt or insecurity • Don’t know how to do this in a healthy manner, so it’s done by compulsions. • Could also be symbolic-for example, if a child is told that something that they did was “dirty,” they might start to compulsively hand wash to get rid of the guilt. • Most researchers today don’t buy • in to this “environment only” theory.

42. Theories on the Causes of OCD • Defect in the amount of brain chemicals-particularly serotonin. • Results in circuits in the brain being triggered over and over again to endlessly repeat actions. • Could be linked to genetics or environmental factors.

43. Help for People with OCD • Medications like Prozac that target serotonin receptor sites in the brain can be very effective. • Cognitive-behavioral therapy has also been shown to be effective-especially exposure therapy. http://www.youtube.com/watch?v=B-qtnCiX5b4&safety_mode=true&persist_safety_mode=1

44. Answer the following questions on a scrap piece of paper according to the following scale: • 1=Not at all • 2=A little bit • 3=Moderately • 4=Quite a bit • 5=A great deal

45. Somatoform Disorders • Conditions in which psychological issues are expressed in bodily symptoms (soma=body) in the absence of any real physical problem. • 1. Conversion Disorder (hysteria) • Disorder in which a serious psychological trauma is unconsciously changed into a symbolic physical dysfunction • Examples: hysterical blindness or hysterical paralysis • A person suffering from conversion disorder is not faking-the symptoms are real, but there just is no physical cause. • Usually the sufferer shows little concern regarding his/her condition.

46. Hypochondriasis • Disorder characterized by feeling excessive concern for one’s health and exaggerating the seriousness of minor physical complaints • Examples: Headache interpreted as a brain tumor or a stiff neck = meningitis. • Less rare than conversion disorder • Thought to stem from childhood-sufferers were only given attention when they were sick and never learned better ways of getting attention • Not to be confused with Munchausen's Syndrome in which the individual purposefully and knowingly harms oneself to fake a disease to get medical attention

47. Body Dysmorphic Disorder • Disorder characterized by preoccupation with your physical appearance and a strong belief that you have an abnormality or defect in your appearance that makes you ugly.

48. Symptoms of BDD • Frequent examination of yourself in the mirror or, conversely, avoidance of mirrors altogether • Belief that others take special notice of your appearance in a negative way • The need to seek reassurance about your appearance from others • Frequent cosmetic procedures with little satisfaction • Excessive grooming, such as hair plucking • Extreme self-consciousness • Refusal to appear in pictures • Skin picking • Comparison of your appearance with that of others • Avoidance of social situations • The need to wear excessive makeup or clothing to camouflage perceived flaws

49. BDD You may obsess over any part of your body, but common features people may obsess about include: • Nose • Hair • Skin • Complexion • Baldness • Breast size • Muscle size • Genitalia • The body feature you focus on may change over time. You may be so convinced about your perceived flaws that you become delusional, imagining something about your body that's not true, no matter how much someone tries to convince you otherwise. • http://www.youtube.com/watch?v=MUKlLpMg-eM&feature=related&safety_mode=true&persist_safety_mode=1