Transcript The philosophical position that every behavior has a cause is known

Mental illness: Around the world
“Disorders” are often attributed to inaccurate beliefs
e.g.,
 Windigo - an animal spirit enters your body and you must
then consume human flesh (young Algonquin tribal
warriors). Tx by killing the individual.
 Koro - belief that your genitals are retracting into your
abdomen (Malaysian men - word for tortoise). Tx with
pegs, clamps, concerned family members.
Body dysmorphic disorder?
Delusional disorder?
Mental illness: In the U.S.
 Each year there are over 2 million admissions to
mental hospitals/psychiatric units in the U.S.
 As many as 1 in 5 are judged to need such
services
 Deinstitutionalization in the 1950s due to advent of
psychotropic medications
 Szasz’s view (“The myth of mental illness”) is in
contrast to the general medical model of
psychiatric illness.
 Over medicating children?
Criteria for abnormal behavior?




Deviant – relative to norms (time and place)
Distress –creates distress in self or others
Dysfunction – work, relationships
Danger – to self (the inability to care for self or
active threat) or to others
All disorders in the U.S. are defined by the
DSM-IV-TR
Phobias (fears)
 Anxiety results from thinking about or being exposed to
something. Intense fear that is non-normative and results
in a dysfunction.
– Specific phobias (e.g., arachnophobia, ophidiophobia, acrophobia,
aerophobia) involve a single stimulus
– Agoraphobia (market place), social phobia (performance, social
settings), and generalized anxiety disorder are not commonly
associated with a single stimulus
– Behavioral interventions work well for specific phobias (tx is
generally less successful for others)
– Anti-anxiety medications (e.g., Xanax) are commonly administered
as tx
Obsessive-compulsive dis.
 Obsessions – intrusive thoughts (e.g., hands are
dirty, your children are in danger, etc.)
 Compulsions – behaviors intended to address the
intrusive thoughts; these rarely occur in the
absence of obsessions (e.g., washing, checking)
– e.g., Howard Hughes?
 Also treated with behavioral interventions
(exposure with response inhibition) in combination
with medications to reduce anxiety
Major Depression
 Marked by extreme sadness, crying, lack of
motivation, isolation, disturbance of sleep,
appetite, sex drive, & may include suicide attempts
 10% incidence in U.S.; 25% for lifetime
 Twice as common in women with 1st episode
usually occurring at 24-29 yrs!
 Exogenous vs. endogenous
– Differ re: cause, course, and treatment success
 Tx most successfully with cognitive interventions
Treatment for depression
 Beck/Ellis cognitive restructuring
– Errors in thinking, automatic thoughts,
overgeneralization, learned helplessness, etc.
 Tx with medications that alter dopamine and/or seratonin
levels (reuptake or release) e.g., Prozac, recent study on
SSRIs shows them to be minimally effective (no significant
improvement over placebo)
 Effects of antidepressants may be due to the fact that they
result in neurogenesis (Duman & Hen, 2003; Science)
– This would explain the 3-4 week delay in the effects
 ECT – highest efficacy, low cost, and fewest side-effects
Suicidal behavior
3 criteria necessary for an involuntary hospitalization
 1. Thoughts – thoughts about one’s own death
 2. Plan – explicit plan on how to commit suicide
 3. Access to means – able to execute plan
 Gender differences – females 4X more likely to attempt
and males 3X more likely to succeed (similar overall rates
of suicide)
– Effects of method (e.g., differences in lethality)
– Best predicted by past attempts, psychiatric conditions, presence of
firearms, and alcohol/drugs
Bipolar disorders
 Previously referred to as manic-depression
 Bipolar disorders involve some combination of
depression and manic episodes (little or no sleep,
excessive energy, spending sprees, hypersexual,
& impulsive travel). (Bipolar I – manic; II – dep)
 Onset is typically late 20s and 30s
 Mood stabilizers such as lithium are used
 Psychotic experiences can occur (manic state)
 Cycling of moods varies considerably
Schizophrenia
Break from reality
Positive symptoms are most prominent:
 Delusions - what makes a belief delusional?
– Not just an inaccurate belief
– Also conviction, resistance to change, normativeness,
impact
– From Trekkie to nut
 Hallucinations – perceptual aberrations
– Auditory, visual, tactile, and/or olfactory
– Hallucinations may be causally linked to delusions
Schizophrenia - continued
 Negative symptoms include loss of motivation/interest,
disorganized speech, flat affect
 Incidence is approx 1%, though higher if you include
personality versions (milder forms)
 Onset varies, but the earlier the poorer the prognosis
 Types included:
(1) Paranoid (persecutory, grandeur, erotomatic),
(2) catatonic (motor retardation),
(3) disorganized (cognitive & behavioral confusion), &
(4) Undifferentiated
See video clip
Delusional disorders
 Delusional disorder – only symptom manifested is
the delusion itself
 Brief psychotic episode – may be associated with
a major life change such as a postpartum
psychotic episode (.1%)
 Shared psychotic disorder – more than 1 individual
sharing the same delusion
 Capgrass syndrome – specific delusion involving
the replacement of people with look-a-likes
 Psychosis proneness – Chapman & Chapman
Causal Features?
 Cognitive deficits – no real reasoning deficits, but
such individuals show a bias for arriving at
conclusion based on less evidence and then
maintain those conclusions (colored balls in a jar;
Hemsley & Garety, 1986)
 Psychosis proneness predicts the endorsement of
abnormal attributions in college students
 Genetic features: incidence is 48% if both parents
or an identical twin has schizophrenia, but only
17% if fraternal twin or 1 parent has it
Treatments - continued
 Almost always involve psychotropic meds
especially to treat the positive symptoms
– Dopamine hypothesis (excess dopaminergic activity)
– These drugs typically have very strong side effects
 Complete resolution is not common, though
individuals can lead functional lifestyles
 Other models? (enlarged ventricles so less brain
matter, eye tracking problems, inadequate early
reinforcement, latent homosexuality, etc.)
Eating disorders
 Anorexia nervosa – extreme weight loss with persistent
belief that one is fat, intense fear/guilt of gaining weight,
90% of cases occur in females
– When emaciated females are amenorrhea
– Typically occurs in 1% of females aged 12-18yrs (early
college late high school)
– Largely limited to Western cultures
 Bulimia nervosa – combination of binging and purging (the
latter can be vomiting, laxatives, or excessive exercise)
– With expanded definition it is almost as common in
males (45%)
Causal factors?
 Major emphasis is on social and cultural
factors
 Physiological effects can occur as a result of
semi-starved diet
– Observed in rats that are placed on such diets
and given an exercise wheel
– Prisoners on semi-starved diets likewise
displayed preoccupation with food
– Effects of excessive exercise and diets?
Somatoform disorders
 Hypochondriasis – preoccupation and fear of
illness
 Somatization disorder – endorsement of many
symptoms with no apparent physical cause
 Body dysmorphic disorder – preoccupation with a
perceived physical deficit
 Conversion disorder (indifference, selective
symptoms, selective demonstration, neurological
nonsense)
– Pseudocyesis – false belief of being pregnant with
physical consequences (enlarged abdominal area and
lactation)
DID (formerly MPD)
 Dissociative identity disorder – loss of time
(amnesia), and a minimum of two distinct
identities.
– How many identities?
– Knowledge between identities?
– 1-4% incidence (small percentage of doctors
diagnose virtually all cases)
Stages of Memory
Storage
Retrieval
Recall affected by context
 Questions can serve as the context for
information recall
– e.g., How fast were the cars going when they
“Hit” vs. “Smashed” each other?
– As time passes, memory integrity decreases
– Confuse contextual information with actual
memory (disruption at the level of retrieval)
Memory types
 Effort of recall
– Implicit – recollection occurs without knowledge (e.g.,
write name slowly)
– Explicit – effortful recall (e.g., previous phone #)
 Information type
– Declarative – facts (easy to learn & forget)
– Procedural – a skill (harder to learn & forget; e.g., finger
movements for dialing your phone)
 Some well rehearsed declarative info can become procedural
Memory stores
 Sensory register
– very large capacity
– iconic (1-3s), echoic
(3s)
– short duration
– lost unless rehearsed
 Use of errors in recall
to determine how info
is stored (visually,
semantically, etc.)
 Short term Memory
– limited capacity
– “chunking” into
meaningful groups
(chess study)
– no limit on chunk sizes
– 7 +/- 2
 Long Term Memory
– limitless capacity and
long lasting
– Semantic encoding
Herman Ebbinghaus (late 1800s)
 1) Amount remembered depends on time
spent learning
 2) Serial position effect: When recalling lists,
1st (primacy effect) and most recent or last
(recency effect) things are recalled best.
– Change order of info to improve recall.
– Advantage of going 1st or last in job interviews.
 Most info lost in the first 1-2 days, then a
gradual slope for forgetting
Forgetting
 Decay – as time passes, we lose info. Faster rate
of forgetting when awake (assuming no rehearsal)
 Interference – new info interferes with old
1. Retroactive – info occurring afterwards interferes
2. Proactive – previous info interferes with new info
 Sleeper effect – forget messenger but recall the
message (increases message salience when
messenger was not a good source)
Amnesia
 Results from injury, stressor, or toxicity
– Anterograde – can’t recall info after injury
– Retrograde – can’t recall anything prior to injury
– Episodic amnesia – a specified period of time
 Generally affects declarative, but not procedural
memories
– Psychogenic fugue state (memory loss & flight)
– Alzheimer’s dementia (degraded short term &
new memories)
Sleep
 Approx. a 24.3 hour cycle for circadian rhythms,
but synchronized to external cues to stay on 24 hr
cycle (called entrainment)
 At birth – 17hrs/day; 6 mos. – 13hrs; 5-7 yrs –
adopt adult pattern of 7-9 hrs
 4.5 – 10.5 hrs per day for most people
 Outside this range results in shorter life span
 Sleep deprivation results in abnormal experiences
and can even result in death
 Internal desynchronization can occur when
changing time zones, taking sleep medications, or
even as a consequence of depression
Sleep stages (approx 90 min cycle)
 Stage 1 – relaxed transitional sleep
 Stage 2, 3, 4 – move from relatively fewer alpha
waves to more delta waves
 REM – most dreaming occurs, restorative sleep,
improves memory, approx. 50% of babies sleep
time, occurs after about 1 hour, paradoxical sleep,
REM rebound, essential to survival.
– Sleep medications and alcohol can reduce REM
sleep, but increase overall sleep time.
– Lack of sleep can result in delusions and
hallucinations after 2-3 days
Sleep disorders
 Narcolepsy (sleep attacks)
 Sleep apnea (stop breathing)
 Night terrors (intense nightmares in children
in stage 4 sleep)
 Insomnia (note: people generally
underestimate how much they sleep)
– Improve sleep by using bed only for sleeping
and only when tired
Altered states of consciousness
 Hypnosis – a heightened state of suggestibility (Mesmer)
 Used in clinical settings to facilitate memory recall, treat
disorders such as phobias, reduce or eliminate problematic
behaviors (e.g., smoking, over eating, etc.), and even
“create” experiences such as age regression, past life
channeling, etc.
 Limited empirical support for effectiveness in reducing
smoking, stress, & pain.
 Known facts: It’s not sleep; effectiveness is determined by
subject not the skill of the hypnotist, can’t do things against
your will; motivated un-hypnotized people can do the same
things; and it does not improve memory accuracy.
 Dissociative theory (Hilgard) vs. social cognitive theory
(Spanos; Kirsch; Lynn).
Classes of Drugs
 Stimulants – CNS activators; e.g., cocaine,
nicotine, caffeine, amphetamines, etc.
 Depressants – CNS suppression; e.g., alcohol,
sedatives, Xanax, etc
 Hallucinogens – altered states of consciousness;
e.g., LSD, mescaline, Hashish, PCP
 Narcotics – numbness and stupor (pain relief);
e.g., opium, morphine, heroin, codeine, Demerol,
Darvon, etc.
Regular use of drugs/alcohol
 Leads to tolerance – it takes more of the drug to
have the same physiological effect
– Tolerance is one of the criteria of substance
dependence (as are withdrawal symptoms)
 Reverse tolerance – it takes less of the drug to
achieve the same physiological effect
 Cross tolerance – use of some substances can
result in tolerance for similar substances
 Substance abuse = use + problem behaviors
 Substance dependence = tolerance, withdrawal
 Substance-induced psychiatric disorders (e.g.,
mood, psychotic, etc.)
Expectancy effects and treatment
 Expectancy effects – stronger than the
pharmacological properties of some drugs when in
low to moderate doses
– e.g., alcohol experienced as a stimulant and nicotine
experienced as a depressant
 Studies in “Barlab” = expectancy with no alcohol
results in greater “intoxication” than low to
moderate alcohol without expectancy.
 Treatment begins with abstinence and may move
to controlled use if it is a legal substance
– In NA, AA (12 steps) is the most common
– In UK controlled drinking is most common (> success)
– Controlled drinking = after abstinence, change gulping
to sipping, reduce frequency, and no straight drinks