Note
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Final Study Guide
Chapter 15: Psychological Disorders
Mental Disorders: any behavior or emotional state that:
Causes an individual great suffering
Is self-destructive
Seriously impairs the person’s ability to work or get along with others
Makes a person unable to control the impulse to en danger others
Diagnostic and Statistical Manual of Mental Disorders (DSM): APA’s standard reference manual used to diagnose mental disorders
Critics: inherent problems of DSM
The danger of overdiagnosis
The power of diagnostic labels
Confusion of serious mental disorders with normal problems
The illusion of objectivity
Supporters: it is important to help clinicians distinguish among disorders that share certain symptoms, such as irratability or delusions so they can be diagnosed reliably and treated properly
Generalized anxiety disorder: a continuous state of anxiety marked by:
Feelings of worry and dread
Apprehension
Difficulties in concentration
Signs of motor tension
Panic disorder: an anxiety disorder in which a person experiences recurring panic attacks, periods of intense fear, and feelings of impending doom or death accompanied by physiological symptoms such as rapid heart rate and dizziness
Phobia: an exaggerated, unrealistic fear of a specific situation, activity, or object
Social phobia: individuals become extremely anxious in situations in which they will be observed by others
Agoraphobia: a set of phobias often set off by a panic attack, involving the basic fear of being away from a safe place or person: a “fear of fear”
Posttraumatic Stress Disorder: a disorder in which a person who has experienced a traumatic or life-threatening event has symptoms such as nightmares, flashbacks, insomnia, reliving of the trauma, and increased physiological arousal
Diagnosed if symptoms persist for one month or longer
Obsessive-compulsive disorder (OCD): an anxiety disorder in which a person feels trapped in repetitive, persistent thoughts (obsessions) and repetitive ritualized behaviors (complusions) designed to reduce anxiety
Person understands that the ritual behavior is senseless but guilt mounts if the behavior is not performed
Major depression: a disorder involving disturbances in:
Emotion (excessive sadness)
Behavior (loss of interest in one’s usual activities)
Cognition (thoughts of hopelessness)
Body function (fatigue and loss of appetite)
Origins of Depression:
Vulnerability-stress model: approaches that emphasize how individual vulnerabilities interact with external stresses or circumstances to produce specific mental disorders, such as depression
Genetic predipositions
Violence, childhood physical abuse, and parental neglect
Losses of important relationships
Cognitive habits
When an infant is separated from a primary attachment figure:
Despair
Passivity
Harm to immune system
Many depressed people have a hisotry of:
Separations
Losses
Rejections
Impaired, insecure attachments
Cognitive habits:
Depression: involves specific, negative ways of thinking about one’s situation
Depressed people believe their situation is:
Permanent
Uncontrollable
Rumination: brooding about negative aspects of one’s life | more common in women
Bipolar disorder: mood disorder in which episodes of both depression and mania (excessive euphoria occur)
Personality disorder: impairments in personality that cause great distress or an inability to get along with others
Borderline personality disorder: characterized extreme negative emotionality and inability to regulate emotions
Antisocial personabilty disorder: characterized by a lifelong pattern of irresponsible, antisocial behavior such as law-breaking, violence and other impulsive, restless acts
Psychopathy: a personality disorder characterized by:
Fearlessness
Lack of empathy, guilt, and remorse
The use of deceit
Coldheartedness
It is not the same as benign violent and sadistic
It is not the same as being psychotic
“Born, not made” appears to be wrong
The belief that psychopaths cannot change is wrong
Biological model: addiction is due primarily to a person’s neurology and genetic predisposition:
Begins in early adolescence
Is linked to impulsivity, antisocial behavior, criminality
Genes affect sensitivity to alcohol
Heavy drug abuse changes the brain and makes addication more likely
Addiction patterns vary accordion to cultural practices
Policies of total abstinence tend to increase addiction rates rather than reduce them
Not all addicts have withdrawal symptoms when they stop taking a drug
Addication does not depend on properties of the drug alone but also on the reason for taking it
The biological model
Addiction is genetic, biological or a chronic relapsing disease caused by changes in the brain produced by drug use
Once an addict, always an addict
An addict must abstain from the drug forever
A person is either addicated or not
The solution is medical treatment and membership in groups that reinforce one’s permanent identity as recovering addict
An addict needs the same treatment and group support forever
Dissociative Identity Disorder: a controversial disorder marked by the appearance within one person of two or more distinct personalities, each with its own name and traits
Formerly known as Multiple Personality Disorder (MPD)
Symptoms of Schizoprenia: psychotic disorder marked by delusions, halluciations, disorganized and incoherent speech, inappropriate behavior, and cognitive impairments
Bizarre delusions
Hallucinations
Disorganized, incoherent speech
Grossly disorganized or catatonic behavior
Negative symptoms
Genetic predispositions
Prenatal problems or birth complications
Biological events during adolescence
Damage to the fetal brain increases likelihood of schizophrenia later in life
May occur as a function of a maternal malnutrition or illness
May also occur if brain injury or oxygen depriviation occurs at birth
There are other nongentic prenatal factors
Chapter 16: Therapy and Treatment
Dorthea Dix: was a social reformer who became an advocate for the indigent insane and was instrumental in creating the first American mental asylum. She did this by relentlessy lobbying state legislatures and Congress to set up and fund such insitutoins
The Question of Drugs
Antipsychotic drugs
Used primarily in treatment of schizoprenia and other psychotic disorders
Designed to block or reduce the sensitivity of brain receptors that respond to dopamine
Some also block serotonin
Can cause troubling side effects such as muscle rigidity, hand tremors, involuntary muscle movements
Antidepressant drugs
Used primarily in treatment of depression, anxiety, phobias, OCD
Monoamine oxidase inhibators (MAOIs) : Elevate norepinephrine and serotonin in brain by blocking an enzyme that deactiviates these neurotransmitter
Tricyclic antidepressants: boost norepinephrine and serotonin by preventing reuptake
Selective serotinin reuptake inhibitors (SSRIs): work on the same principle as tricyclics but specifically target serotonin
Anti-anxiety drugs
Drugs commonly presribed for patients who complain of unhappiness, anxiety, or worry
Increase the activity of GABA
May temporarily help but are not considered a treatment of choice over time
Lithium carbonate
Used to treat bipolar disorder
Must be given in exactly the right dose
Bloodstream levels must be carefully monitored
Too little will not help
Too much is toxic
Some cautions about drug treaments:
Placebo effect:
The apparent success of a medication or treatment due to the patient’s expectations or hopes rather than to the drug or treatment itself
After a while, when placebo effects decline, many drugs turn out to be neither s effective as promised nor widely applicable
High relpase and dropout rates:
There may be short-term success, but 50-66% of patients stop taking medication due to side-effects
When they do, they are likely to relapse, especially if they have not learned how to cope with their disorders
Disregarded for effective, possibly better nonmedical treatments
The popularity of drugs has been fueled by pressure from managed-care organiztions and by drug companies’ marketing and adverstising efforts
Research shows that nonmedical treatments may work as well or even better
Unknown risks over time and drug interactions
Untested off-labels uses
Prefrontal lobotomy: instrument is used to crush nerve fibers running from prefrontal lobes to other areas
Electroconclusive therapy: brief brain seizure is induced
Transcranial magnetic stimulation: involves use of pulsing magnetic coli held to a person’s skull over the left prefrontal cortex
Deep brain stimulation: requires surgery to implant electrodes into the brain and to embed a small box, like a pacemaker under the collarbone
Major schools of psychotherapy
Humanist and existential therapy
Family and couples therapy
Psychdynamic therapy
Behavior and cognitive therapy
Psychoanalysis: a therapy of personality and a method of psychotherapy developed by Sgmund Freud that emphasizes the exploration of unconscious motives and conflicts, modern psychodynamic therapies share this emphasis but differ from Freudian analysis in various ways
Transference: in psychodynamic therapies, a critical process in which the client transfers unconscious emotions or reactions, such emotional feelings about his or her parents onto the therapist
Behavior and Cognitve Therapy:
Graduated exposure: person suffering from a phobia or panic attacks is gradually taken into the feared situation or exposed to a traumatic memory until the anxiety subsides
Flooding: client is taken directly into a feared situation until his or her panic subsides
Systematic desensitization: a step-by-step process of desensitizing a client to a feared object or experience; based on counterconditioning
Behavioral self-monitoring: keep careful data on the frequency and consequences of the behavior to be changed
Skills training: an effort to teach a client skills or new constructive behaviors to replace self-defeating ones
Graduated exposure: person suffering from a phobia or panic attacks is gradually taken into the feared situation or exposed to traumatic memory until the anxiety subsides
Cognitive therapy: a form of therapy designed to identify and change irrational, unproductive ways of thinking and hence to reduce negative emotions
Rational emotive behavior therapy: a form of cognitive therapy devised by Albert Ellis, designed to challenge the client’s unrealistic thoughts
Cognitive-behavioral Therapy: thoughts and behavior influence each other
More common than either cognitive or behavior therapy alone
Family therapy: individual problems develop in the context of the family, are sustained by the dynamics of the family, and any change will affect all members of the family
Family-systems perspectives: an approach to doing therapy with individuals or families by identifying how each family membor forms part of a larger interacting system
In couples therapy, the therapists usually sees both partners in a relationship to help them
Cut through blaming and attacking
Resolve their differences
Get over hurt and blame
Make behavioral changes
Integrative approach: in practice, most therapists integrative, drawing on methods and ideas and avoiding any strong allegiances to any one theory
Family and couples therapy
Behavioral and cognitive therapy
Humanist and existential therapy
Psychotherapy
Therapeutic alliance: the bond of confidence and mutual understanding established between therapists and client, which allows them to work together to solve the client’s problems
The scientist-practioner gap: different assumptions are held by researchers and many clinicians regarding the value of empirical research for doing doing psychotherapy and for assigning and for assessing its effective
The gap has widened because of the proliferation of unvalidated therapies in a crowded market
How treating the mind changes the brain
The fact that a disorder appears to have biological origins or involve biochemical abnormalities does not mean thay biological treatments are the only or most appropriate ones
Psychotherapy or simply having other new experiences an change brain patterns just as medication can