Transcript AbnTreatslides-bk

Personality
Stability vs. Situation?
Personality
• Traits vs. States vs. Types
• 18,000 personality terms to 32 traits to• Big five:
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Extraversion (outgoing, sociable, positive)
Neuroticism (prone to negative emotions)
Conscientiousness (organized, efficient, disciplined)
Openness to experience (non-conventional,
curious)
– Agreeableness (trusting & easygoing with others)
40 to 60% heritable
Situationism
• Low correlations across situations
– Strong vs. weak situations
– But-brain differences and heritability
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Introverts more sensitive to external stimuli
More reactive central nervous system
Low pain tolerance
Underactive Nor-epi system
Sensation seeking extraverts
Heritability: Big five correlations
• Identical twins vs. fraternal twins :
Identical
• Reared together- .51
.23
• Reared apart.50
.21
Fraternal
Personality Theories
• Psychoanalytic
– Childhood experience, ucs influence, dynamics,
conflict, defenses, development and identification
• Humanistic
– Focus on self & self-actualization, existential
approach, flow & happiness
• Social-Cognitive Theory
– Beliefs, thoughts & personal constructs shape
behavior
• Behavioral Theory
– Learning history, self-perception theory, self-control
Defining Abnormality
• Medical approach
• Statistical approach
• Functional approach
These reflect two basic views of disorders
--brain based
--behavior/experience/situation based
The “two worlds” of psychiatry
DSM-IV
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Axis 1: Syndromes (Scz, Depress, etc.)
Axis 2: Retardation & Personality Disorders
Axis 3: General Medical Condition
Axis 4: Social/Environmental Problems
Axis 5: Global Assessment & Coping
Older classification (primarily of Axis 1 & 2)
dichotomized: Neuroses & Psychoses
• Mood (Dep. Bipolar) vs. Thought (Scz) Disrdr
Heritability of Psychosis: Schizophrenia
Scz incidence & poverty/residential area
Prevalence of Neurotic Disorders by Age
Prevalence of Neurosis by Age & Social Class
Prevalence of Psychosis by Age & Gender
Some Interim Conclusions
• Psychoses (focus on SCZ) is a disorder
of heredity and/or prenatal environment
• But it’s also a disorder of poverty (and
that may be bidirectional)!
• Another view of prevalence and recent
dramatic changes in prevalence
Incidence & Prevalence
• Schizophrenia: approx. 1%
• Bipolar Disorder: approx. 1%
• Depression:
approx. M 13% F 21%
Different Therapies for
Different Conditions
• Medical: Brain targeted drug interventions
examples:
--SCZ: Dopamine receptor blockers (the
better the block the more effective it is)
--Other neurotransmitters involved as well
--Depression: ex. Norepinephrine uptake or
release+, Serotonin release+, & a host of
other neurotransmitter controls involved
-- Electro-convulsive shock therapy!
Psychological Therapies
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Psychoanalytic
Behavioral
Client-centered
Cognitive-behavioral
Existential
Eclectic
Situational
Commonalities
• Just as there are some common underlying
aspects of disorders (chemical imbalance,
brain disease, stress, social disconnection)
there are commonalities of psychotherapy.
• Correcting the neurological imbalance can
correct our thinking and so can working
directly on our thinking and behavior.
• A two-pronged approach may be best.
One More Outcome Study
• In a recent meta-analysis comparing drug
with psychotherapy approaches to treating
depression, drugs resulted in a 55%
improvement, psychotherapy 52% and a
combination of the two 85%!! (New England J. of
Medicine, 5-18-’00.)
• Mind and body interact, we shouldn’t be
surprised!
Some Over-arching Issues
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Therapy works!
Comparative studies
It’s the therapist as much as the theory
Meta analyses
Cost is driving the system now!
What to do?
• Keep wits about you & get recommendations from
knowledgeable people
• Don’t try to tough it out--it’s not weakness!
• Make sure therapist listens and understands
• Realize that there are setbacks along the way and
that it takes time
• Remember that heredity vs. environment isn’t
“either-or” but a set of interactions--so changing
situations is important in any case
• Finally, remember that most people get better!