Disorders & Treatments

Distinguishing Mental Disorder from Normality

There is no single, definitive criterion that distinguishes a mental disorder from normality. Instead, psychologists and psychiatrists look for a combination of the following indicators: - Statistical Rarity: Behavior that is uncommon in the general population. - Subjective Distress: The individual experiences personal suffering or emotional pain due to their condition. - Impairment in Daily Functioning: The condition interferes with the individual's ability to maintain relationships, perform a job, or handle day-to-day responsibilities. - Societal Disapproval: The behavior violates social norms or is met with stigma and disapproval by society. - Biological Dysfunction: Evidence of abnormalities in brain structure, brain chemistry, or genetic predispositions.

Historical Views of Mental Disorder

Demonic Model: - Predominant during the Middle Ages, this view held that mental illness was caused by evil spirits inhabiting the body. - Treatments: Included exorcisms to drive out demons and trepanning, a process of drilling holes into the skull to allow spirits to escape.
Medical Model: - This view treats mental illness as a physical disorder requiring medical treatment. - The early medical model was not always scientific. For instance, bloodletting was a common practice. Physicians believed excessive blood caused mental illness and would drain up to $4\,lbs$ of blood, which constitutes approximately $40\%$ of the body's total blood volume. - Other early "medical" treatments involved frightening patients "out of their diseases," such as tossing them into snake pits.
Asylums: Historical institutions for the mentally ill characterized by horrible, squalid conditions.
Moral Treatment: An approach aimed at treating patients with dignity and respect in a more humane environment.

The Rise of Pharmacological Treatment and Deinstitutionalization

Chlorpromazine (Thorazine): - Introduced in the $1950s$ as the first truly effective psychiatric medication. - It provided relief for patients suffering from a loss of contact with reality. - The success of this medication allowed patients to leave asylums, return to their families, and hold jobs.
Deinstitutionalization: - Occurred during the $1960s$ and $1970s$ . - This policy involved releasing patients into the community and closing down large-scale mental hospitals.

The Diagnostic and Statistical Manual of Mental Disorders (DSM)

The DSM-V (and previous versions like DSM-IV-TR) is the definitive "big book of disorders."
Function: It classifies disorders and describes their symptoms.
Limitations: The manual does NOT explain the causes of the disorders or suggest specific cures.

Anxiety Disorders

Anxiety disorders are the most prevalent of all mental health conditions, affecting approximately $29\%$ of the population.
Generalized Anxiety Disorder (GAD): - Characterized by continual feelings of worry, anxiety, physical tension, and irritability across various areas of life. - Individuals with GAD are often called "worry warts." While the general population spends about $18\%$ of the day worrying, those with GAD spend approximately $60\%$ of their day worrying.
Panic Disorder: - Panic Attack: A brief, intense episode of fear accompanied by sweating, dizziness, light-headedness, racing heartbeat, chest pain, and feelings of impending death. - Approximately $20-25\%$ of college students report having at least one panic attack. - Panic Disorder Diagnosis: Requires repeated and unexpected panic attacks, persistent concerns about when the next attack will occur, and major changes in behavior to avoid future attacks.
Phobias: - An intense, irrational fear of an object or situation that is out of proportion to the actual threat. - For a fear to be diagnosed as a phobia, it must restrict the person's life, create considerable distress, or both. - Prevalence: $1$ in $9$ people have a specific phobia of animals, blood/injury, or situations (like thunderstorms).
Agoraphobia: - Often misunderstood as a fear of crowds or public places. - True Definition: A fear of being in a place or situation where escape is difficult or embarrassing, or where help might be unavailable if a panic attack occurs. - Prevalence is approximately $1$ in $20$ people.

Posttraumatic Stress Disorder (PTSD) & Obsessive-Compulsive Disorder (OCD)

Posttraumatic Stress Disorder (PTSD): - An emotional disturbance resulting from witnessing or experiencing a severely stressful event. - Symptoms: - Flashbacks (triggered by stimuli, which can lead to panic attacks). - Recurrent dreams or nightmares of the trauma. - Sleep difficulties and being easily startled. - Avoiding thoughts, feelings, places, and conversations associated with the traumatic event.
Obsessive-Compulsive Disorder (OCD): - Obsessions: Persistent, unwanted, and inappropriate ideas, thoughts, or impulses that cause distress. - Compulsions: Repetitive behaviors or mental acts performed to reduce distress or relieve feelings of shame and guilt. - Individuals with OCD typically recognize that their thoughts are irrational and are disturbed by them. - Time Investment: While people without OCD may spend roughly $1\,hr/day$ on ritual-like behaviors, those with OCD may spend $15-18\,hr/day$ performing rituals.

Influences on Anxiety: Learning and Biology

Learning Models: - Classical Conditioning: Individuals associate a neutral stimulus with an unpleasant experience, acquiring a fear. - Operant Conditioning: Individuals learn to maintain the fear by avoiding the stimulus, which provides negative reinforcement (relief from anxiety). - Observational Learning: Fears can be learned by watching others. - Example (Monkey Study): A wild-reared monkey shows fear of a snake. A lab-reared monkey shows no fear of a snake. However, if the lab-reared monkey observes the wild-reared monkey reacting with fear to a snake, the lab-reared monkey learns that fear. If a barrier masks the snake from the lab-reared monkey's view during this observation, the fear is not learned.
Biological Influences: - PET scans of individuals with OCD show high metabolic activity (indicated in red) in the frontal lobe, suggesting these areas involved with directing attention are overactive.

Therapeutic Interventions for Anxiety and Phobias

Systematic Desensitization: - A behavioral therapy that reduces fear by gradually exposing people to the feared object under controlled conditions. This can involve virtual reality settings.
Flooding: - A sudden, large-scale exposure to the feared object under controlled conditions until the anxiety dissipates.
Questions & Discussion: - Question: What seems to be the main difference between systematic desensitization and flooding? - Response: The primary difference lies in the pacing and intensity of exposure; systematic desensitization is gradual and tiered, whereas flooding is immediate and full-scale.
Drug Therapies: - Benzodiazepines: These are GABA agonists. While they suppress symptoms, the effects are temporary, and the drugs can be addictive. - Antidepressants: Used more effectively as they are not typically taken habitually/addictively.
Therapies for OCD: - Exposure Therapy: Similar to flooding. The patient is exposed to the trigger of the compulsion but is prevented from following through with the ritual. - Response Prevention: The therapist actively prevents the client from performing their typical ritual behaviors. - Medication: The most common pharmacological treatment for OCD is Selective Serotonin Reuptake Inhibitors (SSRIs).

Mood Disorders: Major Depressive Disorder

Over the course of a lifetime, more than $20\%$ of the population will experience a mood disorder.
Major Depressive Disorder (MDD): - Symptoms can develop gradually over weeks or appear suddenly. - DSM Criteria (Group A): Must have $5$ or more of the following for at least two weeks (must include symptom $1$ or $2$ ): 1. Depressed mood most of the day. 2. Markedly diminished interest or pleasure in almost all activities. 3. Significant weight loss (not dieting) or gain (>5\% change per month). 4. Insomnia or hypersomnia nearly every day. 5. Psychomotor agitation or retardation nearly every day. 6. Fatigue or loss of energy nearly every day. 7. Feelings of worthlessness or excessive/inappropriate guilt nearly every day. 8. Diminished ability to think, concentrate, or indecisiveness. 9. Recurrent thoughts of death or suicidal ideation. - Additional Criteria: - Symptoms must cause significant distress or impairment. - They cannot be due to substances/medical conditions or better accounted for by bereavement (unless symptoms persist after $2\,months$ or involve morbid worthlessness/psychotic symptoms).
Course of MDD: - Episodes usually last $6\,months$ to $1\,year$ . - The average sufferer experiences $5-6$ episodes. - $20\%$ of cases are chronic, where depression persists for decades without relief.
Dysthymic Disorder: - A low-level depression lasting at least $2\,years$ . - Symptoms include sadness, inadequacy, hopelessness, low energy, poor appetite, and low productivity.

Explanations and Biology of Depression

Factors: Genetic predispositions, neurotransmitter levels, stressful life events/loss, and interpersonal relationships.
Behavioral Model: Suggests depression results from a loss of reinforcers in everyday life. - Example: Behavioral activation therapy involves "coaching through steps" like showering and doing laundry to re-engage with life.
Learned Helplessness: - Derived from experiments where subjects are subjected to unpleasant stimuli they cannot control. Eventually, they learn to "just give up" because they believe their actions do not matter. This interferes with the ability to take action even when escape is later possible.
Cognitive Model (The Cognitive Triad): - Negative beliefs and expectations regarding: 1. The Self: "I'm ugly/worthless/a failure." 2. The Future: "I'm hopeless because things will always be this way." 3. The World: "No one loves me."
The Depressed Brain: - Increased activity in the amygdala (emotion center). - Decreased activity in the frontal lobe. - Impaired neurogenesis (less growth of new neurons). - Low levels of serotonin and dopamine.

Specialized Mood Disorders and Treatments

Postpartum Depression: - Occurs after childbirth due to changes in hormones/neurotransmitters and the stress of new responsibilities. - Treatment: CBT (identifying struggles, regulating emotions, communication skills), medication (SSRIs), and highlighting strengths/solutions.
Seasonal Affective Disorder (SAD): - Depression that occurs with the change of seasons (usually winter). - Treatment: Phototherapy (exposure to high-intensity light).
General Therapy for Depression: - Behavior Therapy: Monitor/increase positive daily activities, increase assertive behaviors, and use positive reinforcement. - Cognitive-Behavioral Therapy (CBT): Learn to identify and change negative thinking; use between-session experiments to test thoughts. - Optimal Outcome: Usually achieved with a combination of Therapy (Behavioral or CBT) plus Medication (SSRIs).

Bipolar Disorder

Defined by at least one manic episode (a period of extremely high energy, activity, and mood).
Used to be called "manic-depressive."
Age of onset is typically the early $20s$ .
Recurrence: $90\%$ of people who have one manic episode will have another. In more than $50\%$ of cases, a major depressive episode precedes or follows the mania.
Root Causes: - Stressful Events: Increase risk of episodes and frequent relapse. - Positive Life Events: Can also trigger mania (e.g., job promotions or winning a contest). - Genetics: Genes can increase the sensitivity of dopamine receptors and decrease the sensitivity of serotonin receptors.
Pharmacological Treatment: - Mood Stabilizers: Lithium is the standard. - Antipsychotics: Haloperiodol (Haldol), Risperidone (Risperdal), or Chlorpromazine (Thorazine).

Personality Disorders

These are the least reliably diagnosed of all disorders.
Personality Traits: They appear in adolescence, are inflexible, stable over time, and expressed across wide situations, leading to distress.
Borderline Personality Disorder: Characterized by emotional instability and mood swings, often described as "flipping on a dime."
Psychopathic Personality: - Involves low levels of arousal and a lack of empathy or remorse. - Research into frontal lobe causes is ongoing, though many causes remain unknown.

Dissociative Disorders

Involves disruptions in consciousness, memory, identity, or perception.
Dissociative Amnesia: Memory loss for personal information.
Dissociative Fugue: Sudden travel coupled with a loss of memory for one's past. - Example (Case Study): Jeffrey Ingram (age $40$ ) experienced a fugue for over a month, not remembering his life until he saw himself on TV and was identified by his fiancée in $2006$ .
Dissociative Identity Disorder (DID): - Presence of two or more distinct identities (alters). - Alters may have different handwriting, eyeglass prescriptions, respiration rates, and heart rates.
Controversies regarding DID: - Posttraumatic Model: DID is a means of compartmentalizing identity to cope with severe early trauma/abuse ( $90\%$ of cases). - Sociocognitive Model: Claims DID is a product of social and cultural factors. Symptoms may be suggested by therapists through hypnosis or repeated prompting of alters.

Schizophrenia

The most severe of all disorders. While it affects <1\% of the population, it accounts for more than $50\%$ of patients in mental institutions.
Characterized by a loss of contact with reality and disorders of thought and emotion.
Biological Correlates: - Enlarged ventricles in the brain. - Abnormal dopamine receptor sensitivity.
Positive Symptoms: - Delusions: Strongly held, fixed beliefs with no basis in reality. - Hallucinations: Sensory perceptions without external stimuli (auditory, visual, olfactory, or tactile). - Auditory is most common; patients may believe inner speech comes from an external source. - Brain scans show that during auditory hallucinations, the areas associated with speech perception and production are active.
Disorganized Speech: - Language jumps from topic to topic. - Word Salad: Speech becomes so jumbled it is impossible to understand (e.g., mixing parakeets, parking tickets, and sheepdogs in one nonsensical stream).
Catatonic Symptoms: Motor problems including extreme resistance to complying with simple suggestions or maintaining bizarre, rigid postures.

Diathesis-Stress Model and Extreme Treatments

Diathesis-Stress Model: Proposes that psychopathology result from a combination of a genetic vulnerability (diathesis) and environmental stress.
Last Resort Treatments: - Electroconvulsive Therapy (ECT): Passing an electrical current through the brain to induce a seizure; used exclusively for severe, treatment-resistant depression. - Psychosurgery: Brain surgery to treat psychological disorders. The frontal lobotomy was a historical, barbaric procedure that disconnected the frontal lobes from the rest of the brain. It is now obsolete. - Deep Brain Stimulation (DBS): Current experimental or high-level treatment for various neurological and psychiatric conditions.