Transcript Chapter 1
CHAPTER 14 Psychological Disorders Anxiety Disorders Anxiety Disorders • Several kinds of anxiety disorders – – – – generalized anxiety disorder Panic disorders Agoraphobia Specific phobias • Generalized anxiety Disorder: – feeling of stress and unease most of the time – overreacts to stressful conditions. Anxiety Disorders • Panic disorder: – sudden and intense attack of anxiety – symptoms including rapid breathing, high heart rate – feelings of impending disaster. • Agoraphobia: – – – – More a result of panic disorders and generalized anxiety disorder Becomes fearful of situations which elicit panic/anxiety Begin to avoid these areas But generalizes- soon afraid of everywhere! • Phobias – experiences fear or stress when confronted with a particular situation – such as crowds, heights, enclosed spaces, open spaces, dogs, or snakes . Chemical Treatment of Anxiety Disorders • Benzodiazepines – most frequently used anxiolytic (antianxiety) drugs in the past. – increase receptor sensitivity to the inhibitory transmitter GABA. – Suggests deficit in benzodiazepine receptors may be one cause of anxiety disorder. • Anxiety also appears to involve low activity at serotonin synapses. • Antianxiety drugs – initially suppress serotonin activity – then produce a compensatory increase. Related Brain structures and Anxiety Disorders • Number of brain structures activated in anxiety: – amygdala – locus coeruleus. – Both structures participate in more specific emotions, such as fear. • Drugs which decrease action in the locus coeruleus are anxiolytic • Drugs which increase its action increase anxiety. Obsessive compulsive disorders • Obsessive-compulsive disorder (OCD) – consists of two behaviors – obsessions – Compulsions – Often occur in the same person. • Related to anxiety disorders, but often seen in autism spectrum disorders • About 3.3 million American adults ages 18-54 have OCD. (National Institute of Mental Health) www.nimh.nih.gov. • Equally common in both males & females. Obsessive compulsive disorders • Obsession – recurring and intrusive thought. – A person may be annoyed by tune that mentally replays over and over, – Plagued by troubling thoughts such as wishing harm to another person. • Compulsive behavior – – – – Individual compelled to engage in ritualistic behavior touching a door frame three times before passing through endless hand washing Excessive checking to see if appliances are turned off. Obsessive compulsive disorders • Common obsessions: – Repeated thoughts about contamination (public restrooms or shaking hands). – Repeated doubts (leaving lights on or leaving the door unlocked) – Things or objects need to be in a particular place or order (intense distress when objects are disordered or asymmetrical) • Common compulsions: – – – – Hand washing (so repetitive that they become raw). Counting (how many cards in a deck, over and over again). Cleaning (spots on windows) Checking (the lights to make sure they’re off; locked doors every few minutes. – Request/demand assurances – Repeat actions & ordering. Diagnostic criteria for ocd • The person must have recognized at some point that the obsessions or compulsions are excessive or unreasonable. • These recurrent obsessions or compulsions must be severe enough to be time consuming (taking up more than 1 hour per day). • The obsessions/compulsions must cause a marked distress or significantly interfere with the individuals normal routine, occupational functioning, or usual social activities or relationships with others. Onset of OCD • Onset: – – – – Usually begins in adolescence or early adulthood Occasionally in childhood Obsessions or cleaning rituals only vs. checking or mixed rituals Onset is usually gradual. Some acute cases have been diagnosed • Course of the disorder: – May experience a waxing and waning course – About 5% have an episode course with minimal or no symptoms between episodes. – Progressive deterioration in occupational and social functioning – 90% of patients can expect to have moderate to marked improvement with optimum treatment Brain changes in ocd • A variety of studies have identified areas of the brain which appear to be related to OCD • PET studies – OCD patients have increased activity in the orbital frontal cortex – Also in part of the basal ganglia, the caudate nuclei. • Helps explain motor component – Excess activity decreases following • drug treatment • Also with behavior therapy. Brain changes in ocd • White matter abnormalities – suggest defect in connections of the cingulate gyrus – Forms poor connection circuit with the basal ganglia, thalamus, and cortex – Apparently results in a loss of impulse control. • OCD patients problematic serotonergic activity. – SSRI drugs are typically only drugs that consistently improve OCD symptoms • Make serotonin more available in synapse • Alters production/reuptake – Data suggests that OCD patients have too high a turnover of 5HT – Suggests it is the reuptake receptors that may be at fault Behavioral treaments • Cognitive behavioral therapy highly effective for treatment of OCD a) The caudate nucleus (a part of the basal ganglia) and the orbital gyrus; b) the caudate nucleus before and after behavior therapy. Heritability of anxiety disorders • Family and twin studies – anxiety disorders appear to be genetically influenced, – heritability ranging between .20 and .43, depending on the disorder. • Why important to understanding the hereditary underpinnings of anxiety? – significant genetic overlap with other disorders – Dopaminergic or monoamine cluster disorders. Heritability of anxiety disorders • Over 90% of individuals with anxiety disorders also have history of other psychiatric problems. – Overlap with affective disorders is particularly strong. – 50-60% of patients with major depression also have a history of one or more anxiety disorders – panic disorder is found in 16% of bipolar patients. • Family clusters – – – – – – Drug abuse/alcohol abuse ADHD Affective disorders OCD Schizophrenia May all be related somehow Alternative to drug treatment? • People with OCD usually have considerable insight into their own problems. • Most of the time, they know their obsessive thoughts are senseless or exaggerated, and that their compulsive behaviors are not really necessary • However, this knowledge is not sufficient to enable them to stop obsessing or carrying out their rituals • Education is one of the most powerful weapons needed to win the battle over OCD Alternative to drugs? Behavior therapy • Traditional therapy which helps the client gain insight to his or her problem is not recommended for OCD • A specific behavior therapy approach called “exposure and response prevention” is effective: form of Systematic Desensitizaton – Client deliberately and voluntarily exposed to the feared object or idea, either directly or by imagination, – Then is discouraged or prevented from carrying out the usual compulsive response • When treatment works well, the patient gradually experiences lass anxiety form the obsessive thoughts and becomes able to do without the compulsive actions for extended periods of time • A therapist will usually refer an OCD client to a specialist in this kind of therapy Alternative to drugs? Behavior therapy • Long term results from 16 studies showed that, at a mean follow-up of 29 months, 76% of patients were “very much” or “much” improved • Patients who are unwilling to participate in behavior therapy do benefit from only pharmacotherapy treatment, but symptoms reoccur when the medication is stopped. • The effective component of both types of therapy is exposure and ritual prevention Alternative to drugs? Behavior therapy • Studies have shown that OCD patients who participate in both drug and behavioral therapy able to function well in work and social lives • But only if the following factors are included: – The patient must be highly motivated – The patient’s family must be cooperative – The patient must be faithful in fulfilling “homework assignments”