PSYCHOPATHOLOGY
DIAGNOSIS AND
TREATMENT STRATEGIES
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ANXIETY, SOMATOFORM, AND DISSOCIATIVE DISORDERS
Phobias
Generalized anxiety disorder
Panic disorder
Obsessive-compulsive disorder
Conversion disorder
Hypochondriasis
Somatization disorder
Pain disorder
Amnesia/fugue
Dissociative identity disorder (multiple personality disorder)
Disorder
Anxiety disorders
Somatoform disorders
Dissociative disorders
Subtypes Major Symptoms
Intense, irrational fear of objectively nondangerous situations or things, leading to disruptions of behavior.
Excessive anxiety not focused on a specific situation or object; free-floating anxiety.
Repeated attacks of intense fear involving physical symptoms such as faintness, dizziness, and nausea.
Persistent ideas or worries accompanied by ritualistic behaviors performed to neutralize the anxiety-driven thoughts.
A loss of physical ability (e.g., sight, hearing) that is related to psychological factors.
Preoccupation with or belief that one has serious illness in the absence of any physical evidence.
Wide variety of somatic complaints that occur over several years and are not the result of a known physical disorder.
Preoccupation with pain in the absence of physical reasons for the pain.
Sudden, unexpected loss of memory, which may result in relocation and the assumption of a new identity.
Appearance within same person of two or more distinct identities, each with a unique way of thinking and behaving.
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ANXIETY DISORDERS
PANIC DISORDER GENERALIZED ANXIETY DISORDER PHOBIAS OBSESSIVE-COMPULSIVE DISORDER POST-TRAUMATIC STRESS DISORDER
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PANIC DISORDER
Experience reoccurring episodes of anxiety attacks; unpredictable; some situations might become related to it.
Anxiety attack: 5 needed may last a couple of minutes to hours
heart palpitationstense muscles, especially chest muscles often misinterpreted for heart attack, choking sensation from tight neck muscles, faint or dizzy feeling, increase sweat, hot or cold flashes.
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GENERALIZED ANXIETY DISORDER
Persistent level of anxiety lasting at least one month Symptoms:Motor: Tension of muscles: shakes, tremble, unable to relax, twitch, startle easily Autonomic hyperactivity: Sweat, increased heart rate, cold hands, hot, cold flashes, light headed and dizzy Apprehension--worry constantly Vigilance and scanning: hyperattentive to things in the environment, distractible, hard to concentrate, impatient, irritable.
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PHOBIA
Irrational fear response of specific stimuli
SOCIAL PHOBIAS AGORAPHOBIA SPECIFIC PHOBIAS
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OBSESSIVE-COMPULSIVE DISORDER
Marked by overt ritualistic behavior and persistent intruding thoughts
Occurs at a frequency so high as to interfere with daily functioning
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SOMATOFORM DISORDERS
HYPOCHONDRIASIS CONVERSION HYSTERIA
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HYPOCHONDRIASIS
Preoccupation with body and illness No relief if given healthy diagnosisJust as tense--travel and search for new physicians
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CONVERSION DISORDER
Individual has dramatic physical symptoms with no organic cause. 1. Paralysis of legs/arms/ total 2. Anesthesia--lost sense of touch with parts of body 3. Analgesia--feel no pain 4. Other common experiences: nausea, lower back pain, dizziness, hysterical blindness, deafness, unexplained headaches 5. Unusually INDIFFERENT to symptoms 6 .Secondary gain for having symptoms 7. May disappear while asleep or under hypnosis 8. Craft Paralysis: symptoms selective to job--paralyzed hands of violinist or tennis player. 9. Symptoms make no common sense neurologically
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DISSOCIATIVE DISORDERS
DISSOCIATIVE AMNESIA DISSOCIATIVE FUGUE DISSOCIATIVE IDENTITY DISORDER
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DISSOCIATIVE AMNESIA
Memory for certain events from 1 hour to 3 months is lost Person is not distressed by loss of memory--intellectual and skills still there. Theorized as a loss of memory (repression) for traumatic event
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DISSOCIATIVE FUGUE
Amnesia for entire life & selfStarts a new life in a new location -called travelling amnesiac
Cause: extreme stress & need to fleeCan last for days, weeks, years.Extremely rare except on Soaps!
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DISSOCIATIVE IDENTITY DISORDER
Dominance of 2 or more distinct personalities
Generally amnesic for existence of others
Controversial Diagnosis
Diathesis Stress Model of Disorders
Fig13156
Precursors Diathesis Stress Outcome
Geneticfactors
Brain disease
Early learningexperiences
Bad familydynamics
Poor self-understanding
Stressful familydynamics
Social stresses
Vulnerability Disorder (e.g.schizophrenia)
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AFFECTIVE DISORDERS
MAJOR DEPRESSION DYSTHYMIC DISORDER BIPOLAR DISORDER CYCLOTHYMIC DISORDER SEASONAL AFFECTIVE DISORDER
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CLINICAL DEPRESSION
Emotions major disturbing problem but also problem in cognition (self-defeating thoughts) 1. Dysphoric mood for a minimum of 2 weeks plus 4 of following: Change in appetite usually decreaseChange in sleep--insomnia or hypersomniaChange in amount of psychomotor activity-slow or agitatedFatigue or loss of energy Feelings of worthlessness, self critical or inappropriate guilt Poor concentration Suicide or suicidal ideation
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BIPOLAR DISORDER MANIC-DEPRESSION
Elevated mood-elation and mania alternating with depressive thoughts
Mania: inflated self esteem: too self confident talkative w/flight of ideas increased activity, interests, social decreased need of sleep, distracted concern that will harm selves not judge consequences of actions shopping spree--self destructive buying pattern
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INCIDENCE OF DEPRESSIONFig147
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Risk
Prevalence ingeneral population
Fraternal twins
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10
Major depression
Identical twins
Bipolar disorder
Prevalence ingeneral population
Fraternal twins
Identical twins
40
30
60
50
80
70
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Creativity and Madness
WritersHans Christian AndersenWilliam Faulkner (H)F. Scott Fitzgerald (H),ErnestHemingway (H, S), Hermann Hesse (H, SA), Henrik IbsenHenry JamesWilliam JamesSamuel Clemens (MarkTwain)Joseph Conrad (SA)Charles DickensIsak Dinesen (SA)Ralph Waldo EmersonHerman MelvilleEugene O'Neill (H, SA)Mary ShelleyRobert Louis Stevenson Leo Tols toyTennessee Williams (H) MaryWollstonecraft (SA)Virginia Woolf (H, S)
PoetsWilliam BlakeRobert Burn s Lord ByronSamuel Taylor Coleridge EmilyDickinsonT.S. Eliot (H)Oliver GoldsmithGerard Manley HopkinsVictor HugoSamuel JohnsonJohn KeatsJames Russell LowellRobert Lowell (H) Edna St. Vincent Millay (H)Boris Pasternak (H)Sylvia Plath (H, S)Edgar Allan Poe (SA)Ezra Pound (H) Anne Sexton (H, S) Percy Bysshe Shelley (SA)Alfred, Lord Te nnyson,Dylan ThomasWalt Whitman
ArtistsPaul Gauguin (SA),Vincent van Gogh (H, S),Ernst Ludwig Kirchner (H, S),Edward Lear, Michelangelo,Edvard Meunch (H),Georgia O'Keeffe (H),George Romney,Dante Gabriel Rossetti(SA)
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SCHIZOPHRENIA
PARANOID CATATONIA DISORGANIZED HEBEPHRENIA SIMPLE RESIDUAL
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SCHIZOPHRENIA
Disturbed content, including delusions; and disorganization,including loose associations, neologisms, and word salad.
Hallucinations, or false perceptions; poorly focused attention.
Flat affect; or inappropriate tears, laughter, or anger.
Genetics; abnormalities in brain structure; abnormalities indopamine systems; neurodevelopmental problems.
Learned maladaptive behavior; disturbed patterns of familycommunication.
Aspect
CommonSymptomsDisorders ofthought
Disorders ofperception
Disorders ofemotion
Possible CausesBiological
Psychological
Key Features
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Fig15_5
15_05
Low
Min
Max
High
Challengingevents
C
A
Normalbehavior
Schizophrenicbehavior
D
B
Vulnerability
Threshold
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PERSONALITY DISORDERS
ANTISOCIAL AVOID ANT BORDERLINE
DEPENDENT HISTRIONIC NARCISSISTIC
OBSESSIVE-COMPULSIVE
PARANOID SCHIZOTYPAL
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Tab15_5
Fig15_5
Paranoid
Schizoid
Schizotypal
Depedent
Obsessive-compulsive
Avoidant
Histrionic
Narcissistic
Borderline
Antisocial
Type Typical Features
Suspiciousness and distrust of others, all of whom are assumed to be hostile.
Detachment from social relationship; restricted range of emotion.
Detachment from, and great discomfort in, social relationships; odd perceptions, thoughts, beliefs, and behaviors.
Helplessness; excessive need to betaken care of; submissive and clinging behavior; difficulty in making decisions.
Preoccupation with orderliness, perfection, and control.
Inhibition in social situations; feelings of inadequacy; oversensitivity to criticism.
Excessive emotionality and preoccupation with being the center of attention; emotional shallowness; overly dramatic behavior.
Exaggerated ideas of self-importance and achievements; preoccupation with fantasies of success; arrogance.
Lack of stability in interpersonal relationships, self-image, and emotion; impulsivity; angry outbursts; intense fear of abandonment; recurring suicidal gestures.
Shameless disregard for, and violation of, other people's rights.
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PSYCHO-SEXUAL DISORDERS
Fetishism ZoophiliaSadism Masochism
Exhibitionism Pedophilia
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DEVELOPMENTAL DISORDERS
Autism
Academic Skills Disorder
Attention Deficit Disorder w/hyperactivity
Senile Dementia
TREATMENT
PSYCHOANALYSISBEHAVIOR
HUMANISTICCOGNITIVE
BIOMEDICAL
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SIGMUND FREUDPSYCHOANALYSIS
ResistanceCatharsis
TransferenceInterpretation
Insight
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DEINSTITUTIONALIZATION
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APPROACHES TO PSYCHOLOGICAL TREATMENT
Driven by sexual andaggressive urges
Neutral; helps clientexplore meaning of freeassociations and othermaterial from theunconscious
Emphasizes unresolvedunconscious conflictsfrom the distant past
Psychosexual maturitythrough insight;strengthening of egofunctions
Free association; dreamanalysis, analysis oftransference
Dimension
Nature of the humanbeing
Therapist’s role
Time frame
Goals
Typical methods
ClassicalPsychoanalytic
ContemporaryPsychodynamic Phenomenological Behavioral
Driven by the need forhuman relationships
Active; developsrelationship with client asa model for otherrelationships
Understanding the past,but focusing on currentrelationships
Correction of effects offailures of earlyattachment; develop mentof satisfying intimaterelationships
Analysis of transferenceand countertransference
Has free will, choice, andcapacity for self-actualization
Facilitates client’s growth;some therapists areactive, some nondirective
Here and now; focus onimmediate experience
Expanded a wareness,fulfillment of potential;self-acceptance
Reflection-orientedinterviews designed toconvey unconditionalpositive regard, empathy,congruence; exercises topromote self-awareness
A product of sociallearning and condi tioning;behaves on the b asis ofpast experience
Teacher/trainer wh ohelps client replaceundesirable thoughts andbehaviors; active, action-oriented
Current behavior andthoughts; may not needto know original causes inorder to create change
Changes in thinking andbehaving in particularclasses of situations;better self-management
Systematicdesensitization, modeling,assertiveness and socialskills training, positiverein-forcement, aversiveconditioning, punishment,extinction, cog-nitive restructuring
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CARL ROGERSCLIENT CENTERED
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HUMANISTIC THERAPY55
BASIC HUMAN NEEDS
OTHERS' RESPONSES RESULT
SELF GUIDES
MENTAL HEALTHEFFECTS
Self-actualization
Self = oughts
Self = ideals
AnxietyShameGuilt
SadnessDisappointmentDepression
Need forself-actualization
Need forpositive regard
Unconditionalpositive regard
Conditionalpositive regard
Self-discrepancies
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ROLLO MAYEXISTENTIAL THERAPY
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ALBERT BANDURAMODELING
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BEHAVIOR AND COGNITIVE
SY STEM A TIC D ESEN SITIZA TION
M OD ELIN G
F LOOD IN G
R A TION A L EM OTIV E ELLIS
IM P LOSIV E
STR ESS IN N OCU LA TION
A V ER SION
COGN ITIV E --BECK
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BIOLOGICAL TREATMENTS FOR PSYCHOLOGICAL DISORDERS
Severe depression
Schizophrenia,severe depression,obsessive-compulsivedisorder
Anxiety disorders,depression,obsessive-compulsivedisorder, mania,schizophrenia
Method
Electroconvulsivetherapy (ECT)
Psychosurgery
Psychoactivedrugs
TypicalDisorders Treated Possible Side Effects Mechanism of Action
Temporary confusion,memory loss
Listlessness,overemotionality,epilepsy
Variable, depending ondrug used: movementdisorders, physicaldependence
Uncertain
Uncertain
Alteration ofneurotransmittersystems in the brain
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ELECTRO-CONVULSIVE SHOCK TREATMENT (ECT)
Single most effective treatment for psychotic depression
Used as treatment of last resort Actual understanding of how it works is not
complete--disrupts electrical impulses of brain Within two to four weeks many see profound mood
elevation Side Effects include memory loss (usually short term)
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PSYCHOSURGERY
PREFRONTAL LOBOTOMY Removal of brain tissue to relieve symptoms Pre-frontal lobotomy first used on gorillas and found to calm
aggression; applied to patients in mental institutions beginning in the 1950’s
Often used on schizophrenics bringing flat affect Today smaller amount of tissue can be removed from specific
areas showing malfunction--cingulotomy Can be very effective at removing tumor and other tissue
causing abnormal behaviors
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BIOMEDICAL TREATMENTS
Drug Treatment Options: Anti-Anxiety Xanax
GABA neurotransmitter Anti-Depressant drugs Prozac
Serotonin and Norepinephrine Anti-Psychotic drugs Thorazine
Dopamine
PSYCHOTHERAPY VS NONE 41
Number of
people
No improvement Outstanding
improvement
Average
untreated
person
Average
treated
person
80% ofuntreatedpersons