Transcript PowerPoint Slide Set Westen Psychology 2e

Psychology: Brain, Mind,
and Culture, 2e
by
Drew Westen
Paul J. Wellman
Texas A&M University
John Wiley and Sons, Inc.
PowerPoint  Presentation: Chapter 15
Psychological Disorders
Lecture Outline
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Definitions of Psychopathology
Perspectives on Psychopathology
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Psychodynamic
Cognitive-Behavioral
Biological
Systems
Diagnostic Systems
 DSM-IV
© 1999 John Wiley and Sons, Inc.
Psychopathology
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Psychopathology refers to problematic
patterns of thought, feeling, and behavior
 Disrupted functioning at home, work, and in
the person’s social life
 Patterns that cause distress in the person or
in others
 Psychopathology literally means sickness of
the mind
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Psychopathology varies between and
within cultures
© 1999 John Wiley and Sons, Inc.
Labeling of Mental Illness
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The notion of abnormality carries with it
the presumption that we can define what
is and in not abnormal
 Labeling theory argues that diagnoses of
abnormality are but labels we use for people
who we consider deviant
 Rosenhan study: “Pseudo”-patients claimed
to hear voices and were admitted to various
psychiatric hospitals. Rosenhan noted that
no hospital detected them as fakes. The
study suggests support for labeling theory.
© 1999 John Wiley and Sons, Inc.
Psychodynamic Perspective
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The psychodynamic perspective
recognizes three classes of pathology:
 Neuroses refer to issues in living that involve
anxiety (phobias) or interpersonal conflict
 Personality disorders are chronic and severe
disturbances that alter the capacity to work
and to love
 Psychoses refer to marked disturbances of
contact with reality
 These classes form a continuum of functioning
from minimal to serious disturbance
© 1999 John Wiley and Sons, Inc.
Continuum of Psychopathology
© 1999 John Wiley and Sons, Inc.
Biological Perspective on
Psychopathology
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The biological perspective seeks the roots
of abnormal behavior within the brain
The biological view holds that brain
disturbance results in mental changes
 Gross pathology of the brain: damage to the
frontal lobes associated with syphilis
 Disturbance of neurotransmitter function
• Schizophrenia as too much dopamine
• Depression as too little serotonin
© 1999 John Wiley and Sons, Inc.
Systems Perspective
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The systems perspective seeks the roots
of abnormality in the broad social context
 Each person is a member of a social group
 The group functions as a system and the
system parts are interdependent
• A change in one member may influence other
members
• A father may show evidence of anxiety that is
traced to his children: Father is the symptom
bearer
– Son arrested for driving while intoxicated
– Daughter runs away from home
© 1999 John Wiley and Sons, Inc.
Descriptive Diagnosis
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The current diagnostic system assumes
that we can distinguish normal from
abnormal
 Abnormality is reflected in discrete symptoms
 As in physical illness, symptoms fall into
discrete clusters called syndromes
 Syndromes are assumed to have discrete
causes and are to be treated using different
therapies
 This system is based on the medical model
© 1999 John Wiley and Sons, Inc.
DSM-IV
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The American Psychiatric Association
published a diagnostic manual that attempts
to classify signs and symptoms into
syndromes
 Signs are observable phenomena (temperature)
 Symptoms are reports from patients (headache)
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The current edition is termed the DSM-IV
 The DSM-IV uses a multi-axial system of
diagnosis
• The axes cover symptoms as well as medical
conditions, stress, and current level of function
© 1999 John Wiley and Sons, Inc.
The Axes of DSM-IV
Axis Description
I
II
III
IV
V
Symptoms that cause distress
Personality disorders and mental retardation
Medical conditions that may be relevant to understanding
or treating a psychological disorder
Psychosocial and environmental problems
Global assessment of functioning
(Source: DSM-IV, American Psychiatric Association, 1994)
© 1999 John Wiley and Sons, Inc.
Childhood Disorders
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Attention-Deficit Hyperactivity Disorder is
characterized by inattention, impulsiveness,
and hyperactivity
 Prevalence of ADHD is likely 3-5% of schoolaged children, more common in boys
 ADHD is often treated with Ritalin
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Conduct Disorder refers to the child who
persistently violates rules and norms
 Prevalence is larger in boys than girls
 Conduct disorder may reflect a problem in
conditioning
© 1999 John Wiley and Sons, Inc.
Substance-Related Disorders
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Substance-Related Disorders refer to
continued use of a substance (alcohol) that
impairs social and physical functioning
Alcoholism is a common substance-related
disorder
 Some 13 million in the USA are alcoholic
 Alcoholism is the 3rd largest cause of death
 Heredity plays a large role in alcoholism
• Children of alcoholics are prone to developing
alcoholism, the effect is larger for males than for
females
© 1999 John Wiley and Sons, Inc.
Schizophrenia
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Schizophrenia refers to a profound
disturbance in human function including:
 Thought: Illogical thought systems (delusions)
and loosening of associations
 Perception: Presence of hallucinations
 Language: Word salad, disconnected ideas
 Affect: Emotion (often flat or absent)
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Symptoms can be viewed as:
 Positive: Delusions are an added function
 Negative: Signal the absence of a function (flat
affect)
© 1999 John Wiley and Sons, Inc.
Major Types of Schizophrenia
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Paranoid
Catatonic
Disorganized
Undifferentiated
Residual
© 1999 John Wiley and Sons, Inc.
Biological Basis of Schizophrenia
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Diathesis-stress model proposes that some
persons develop schizophrenia because of
a underlying biological
vulnerability(diathesis) that is compounded
by stress
The heritability of schizophrenia is 50-83%
 Risk of schizophrenia is 48% in monozygotic,
17% in dizygotic twins, and 9% in siblings
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Dopamine hypothesis: schizophrenia
reflects elevated levels of dopamine in brain
© 1999 John Wiley and Sons, Inc.
Neural Atrophy in Schizophrenia
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Neuron loss in brain results in a
diminished volume of brain tissue
 The fluid-filled ventricles enlarge to take up
the volume
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Enlarged ventricles are a common finding
in schizophrenia
 Atrophy of the frontal, temporal, and
prefrontal cortex has been noted in
schizophrenic patients: reflects brain damage
 Note that symptoms induced by brain cell
loss may not respond to drug treatment
© 1999 John Wiley and Sons, Inc.
Mood Disorders
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Mood disorders are characterized by
disturbance of emotion and mood state
 Mania refers to an excessive degree of
happiness, and a belief the person can do
anything
 Major Depressive Disorder refers to a longterm episode of intense sadness, loss of
appetite, and difficulty in sleeping
• Duration may be 5 months or more
• Women are twice as likely to have major
depression (incidence is 2-3% for men and 5-9%
for women)
© 1999 John Wiley and Sons, Inc.
Mood Disorders, Continued
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Dysthymia is a less severe type of
depression
 Symptoms of dysthymia are evident over
longer time periods (two years) but are not as
debilitating as those of major depression
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Bipolar disorder involved alternating
episodes of mania and depression
 Lifetime risk is low (0.5-1.6%)
 Appears more often in upper classes
 Bipolar patients achieve high levels of
education
© 1999 John Wiley and Sons, Inc.
Theories of Depression
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Depression may reflect a biological
vulnerability and an environmental basis
The heritability of depression is about 30%
 Twin studies show a clear role of genetics in
depression
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Effective antidepressant drugs alter
serotonin activity (Prozac blocks the
reuptake of serotonin)
Cognitive theories of depression note that
depressed people have negative cognitive
schemas about themselves
© 1999 John Wiley and Sons, Inc.
Beck’s Negative Triad
(Figure adapted from Beck, 1976, p 256)
© 1999 John Wiley and Sons, Inc.
Anxiety Disorders
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Anxiety disorders refer to feelings of
distress, uneasiness, or apprehension
Types of anxiety disorders:
 Phobias refer to an irrational fear of an object
or situation
• Social phobia: a fear of being in a public situation
 Panic Disorders are intense attacks of anxiety
that are justified by the situation
 Agoraphobia refers to anxiety associated with
being in places or situations from which it
might be difficult to escape (e.g. an elevator)
© 1999 John Wiley and Sons, Inc.
Obsessive-Compulsive Disorder
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An obsession is a persistent thought that
cannot be controlled
 “Did I lock the door?”
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A compulsion is an intentional behavior
(ritual) that occurs in response to a
thought
 Check the door (22 times)
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Key aspect is that OC persons
experience anxiety if they are unable to
complete their ritual
© 1999 John Wiley and Sons, Inc.
Copyright
Copyright 1999 by John Wiley and Sons, New
York, NY. All rights reserved. No part of the
material protected by this copyright may be
reproduced or utilized in any form or by any means,
electronic or mechanical, including photocopying,
recording, or by any information storage and
retrieval system, without written permission of the
copyright owner.
© 1999 John Wiley and Sons, Inc.