psychopathology or psychological disorders

Psychopathology Psychopathology or Psychological Disordersor Psychological Disorders

KING LEAR

PrevalencePrevalence

Lifetime Rates by GenderLifetime Rates by GenderDisorderDisorder MalesMales FemalesFemales TOTAL (%)TOTAL (%)

Anxiety Anxiety disorderdisorder 1919 31 31 2525

Unipolar Unipolar DepressionDepression 1313 2121 1717

ManiaMania 22 22 22

Substance Substance dependencedependence 3535 1818 2727

Any Any disorderdisorder 4949 4747 4848

Diagnosis: A Necessary StepDiagnosis: A Necessary Step DiagnosisDiagnosis

Process of Process of identifying and identifying and grouping mental grouping mental disorders with disorders with similar symptomssimilar symptoms

DSM-IV DSM-IV American American Psychiatric Psychiatric Association’s Association’s Diagnostic and Diagnostic and Statistical Statistical Manual of Mental Manual of Mental DisordersDisorders (4th (4th Edition)Edition)

Advances in diagnosis and therapy are success stories for clinical psychology/ psychiatry

In 1955, 500,000 institutionalized for psychological disorders

Today: 65,000But mental hygiene arrests continue to this day (suicide, squalor, starving)

Major Affective DisordersMajor Affective Disorders

“The mind is its own place, and of itself

Can make a Heaven of Hell, a Hell of Heaven”

- John Milton (Paradise Lost)

Major Affective DisordersMajor Affective DisordersUnipolarUnipolar BipolarBipolar

Incidence Incidence Up to 20 %Up to 20 % 1.6 %1.6 %

Age diagnosedAge diagnosed 25-45 y25-45 y 20-30 y20-30 y

Sex differenceSex difference Twice rate for Twice rate for femalesfemales

No differenceNo difference

Suicide Suicide attemptsattempts

16 %16 % 30 %30 %

Alcoholism %Alcoholism % (10% of most people per (10% of most people per year)year)

30 %30 % 30 %30 %

MZ MZ concordanceconcordance 100% shared genes100% shared genes

41 %41 % 55 %55 %

DZ DZ concordanceconcordance ~ 50% shared genes~ 50% shared genes

15 %15 % 10 %10 %

What is Bipolar disorder?What is Bipolar disorder?

Mood cyclesMood cycles

Creativity & BipolarCreativity & Bipolar

Creativity & Mood Creativity & Mood DysfunctionDysfunction

Writers Writers ControlsControls

Mood disorderMood disorder 80 %80 % 30 %30 %

BipolarBipolar 43 %43 % 10 %10 %

AddictionAddiction 30 %30 % 7 %7 %

SuicideSuicide 12 %12 % 0 %0 %

Iowa Writer’s Workshop, Andreasen, 1987Iowa Writer’s Workshop, Andreasen, 1987

Other studies find 30x normal incidence rate in writers, musicians

Why are they linked?

Famous Bipolar ArtistsFamous Bipolar ArtistsHans Christian Anderson Ludwig von Beethoven Lord Byron Charles Dickens T. S. Eliot Ralph Waldo Emerson William Faukner F. Scott Fitzgerald Paul Gauguin Vincent van Gogh

Ernest Hemingway Michelangelo Sylvia Plath Edgar Allan Poe Gordon Sumner (Sting) Peter Tchaikovsky Leo Tolstoy Mark TwainVirginia Woolf Tennessee Williams

Creativity Connection

• Emotional reactive (unfiltered life)

• Disinhibited (loose associations)

• Absorption (focus)

Intense creative episodes during hypomania

Vicious Cycle of Vicious Cycle of DepressionDepression

Beck Depression Inventory Beck Depression Inventory (BDI)(BDI)

Twenty-one dimensions of depression:1. Sadness 12. Social withdrawal2. Pessimism 13. Indecisiveness3. Sense of failure 14 Change in body image4. Dissatisfaction 15. Retardation5. Guilt 16. Insomnia6. Expectation of punishment 17. Fatigability7. Dislike of self 18. Loss of appetite8. Self Accusation 19. Loss of Weight9. Suicidal ideation 20. Somatic preoccupation10. Episodes of crying 21. Low level of energy11. Agitation

In past week including today:0 = I do not feel sad1= I feel sad2= I am sad all the time and I can’t snap out of it3= I am so sad that I can’t stand it

0-63 max score (30+ indicates severe depression)

Aaron Beck

Treatment for Unipolar Treatment for Unipolar

CognitiveCognitive DrugDrug ECTECT

ImprovemenImprovementt

70%70% 70%70% 80%80%

Relapse rateRelapse rate ModeratModeratee

HigherHigher HigherHigher

Side effectsSide effects NoneNone ModeratModeratee

severesevere

AntidepressantsAntidepressants

SuicideSuicide30,000 Americans each year

Nearly 2x the homicide rate

8th leading cause of death,

3rd for teens

2 x above the world rate- 16.7/100K Japan (1997)- 11.9/100K USA (1997)

Females attempt 3x males, but males succeed 4x

60% successes with firearms

Since 1950, suicide rates in teens has tripled

Myth of Sisyphus (Camus): “There is only one really serious philosophical question, and that is suicide”

Suicide in Depression Suicide in Depression CycleCycle

Anxiety DisordersAnxiety Disorders

PhobiaPhobia

Intense irrational fear of object or situation

Obsessive-Compulsive Obsessive-Compulsive Disorder (OCD)Disorder (OCD)

• Obsessions: repetitive thoughts

- germs, terrible events, symmetry & order

• Compulsions: repetitive behaviors

- grooming, rituals, checking locks, appliances

Dissociative Identity Dissociative Identity DisorderDisorder

• Previously Previously Multiple Multiple personality personality disorders disorders (MPD)(MPD)

SchizophreniaSchizophrenia

““Split Mind”Split Mind”

Disorders Disorders involving gross involving gross distortions of distortions of thoughts and thoughts and perceptions and by perceptions and by loss of contact loss of contact with realitywith reality

Scz – the Disorder of Science and MathScz – the Disorder of Science and Math

Isaac Newton – suffered psychotic Isaac Newton – suffered psychotic break break

Albert Einstein – autistic traits, Scz sonAlbert Einstein – autistic traits, Scz son

John Nash Jr – chronic schizophreniaJohn Nash Jr – chronic schizophrenia

Bertrand RussellBertrand Russell

James Joyce’s daughterJames Joyce’s daughter

Syd Barrett (of Pink Floyd)Syd Barrett (of Pink Floyd)

Socrates (perhaps, or Socrates (perhaps, or

temporal lobe epilepsy)temporal lobe epilepsy)

Types of SchizophreniaTypes of Schizophrenia

• ParanoidParanoid: Delusions or : Delusions or hallucinations often include hallucinations often include extreme suspiciousness and extreme suspiciousness and hostility hostility

• DisorganizedDisorganized: Exhibit signs : Exhibit signs of illogical thinking and of illogical thinking and speechspeech

• CatatonicCatatonic: Exhibit : Exhibit extremes in motor behaviorextremes in motor behavior

• UndifferentiatedUndifferentiated: Do not : Do not clearly fit into a typeclearly fit into a type CatatoniaCatatonia

Positive & Negative Positive & Negative SymptomsSymptoms

• Positive Sx: cognitive, emotional, Positive Sx: cognitive, emotional, and behavioral and behavioral excessesexcesses..– hallucinations, delusions, thought disorders, and hallucinations, delusions, thought disorders, and

bizarre behaviors.bizarre behaviors.

• Negative Sx: cognitive, emotional, Negative Sx: cognitive, emotional, and behavioral and behavioral deficitsdeficits..– apathy, flattened affect, social withdrawal, apathy, flattened affect, social withdrawal,

inattention, and slowed speech or no speech.inattention, and slowed speech or no speech.

Schizophrenia ratesSchizophrenia rates

• 1% across all cultures, despite few offspring1% across all cultures, despite few offspring• Male = females, or slightly more malesMale = females, or slightly more males• More in jails than psychiatric hospitalsMore in jails than psychiatric hospitals• 50% never accept that they are ill50% never accept that they are ill• 90% go off meds once+ (relapse within 3y)90% go off meds once+ (relapse within 3y)• Nearly 100% smoke (self-stimulation)Nearly 100% smoke (self-stimulation)• Higher prevalence in lower socioeconomic classHigher prevalence in lower socioeconomic class• 25% full remission, 50% recurrent relapses 25% full remission, 50% recurrent relapses

(living independently on meds or less (living independently on meds or less autonomously in group homes), 25% autonomously in group homes), 25% permanently hospitalizedpermanently hospitalized

• 40% attempt suicide, 10% succeed40% attempt suicide, 10% succeed

DSM-IV CriteriaDSM-IV Criteria

•DelusionsDelusions

•HallucinationsHallucinations

•Speech changesSpeech changes

•Motor symptomsMotor symptoms

•Mood symptomsMood symptoms

•Cognitive symptomsCognitive symptoms Must show 2 of following for 6 monthsMust show 2 of following for 6 months

Delusions – incorrect Delusions – incorrect conclusions conclusions about about

perceptionsperceptions•Peculiar beliefs, culturally based Peculiar beliefs, culturally based

aliens, secret lovers, paranoia, grandiosity, thought aliens, secret lovers, paranoia, grandiosity, thought insertion or broadcast, erotomaniainsertion or broadcast, erotomania

• Ideas of reference Ideas of reference events has special personal meaningevents has special personal meaning

•Magical thinking Magical thinking control events from afarcontrol events from afar

Hallucinations Hallucinations – inaccurate – inaccurate perceptionsperceptions

Most auditory; some visual, olfactory, Most auditory; some visual, olfactory, tactiletactile

•Commanding voice of authority – Commanding voice of authority – God, historical figure, parent alive God, historical figure, parent alive or deador dead

•Derisive, insultingDerisive, insulting

•Running commentary of life, Running commentary of life, feelings, thoughtsfeelings, thoughts

Speech changesSpeech changes

•Mute vs pressured (“word salad”)Mute vs pressured (“word salad”)

• Insensitive to the informational Insensitive to the informational needs of audienceneeds of audience

•Overall, a poverty of speechOverall, a poverty of speech

Motor symptomsMotor symptoms

•CatatoniaCatatonia

•Peculiar (e.g., strip naked to greet)Peculiar (e.g., strip naked to greet)

•Bizarre gestures, grimacesBizarre gestures, grimaces

•Stereotypies (rocking, flapping)Stereotypies (rocking, flapping)

•Violence to self, or family Violence to self, or family membersmembers

Mood symptomsMood symptoms

•Blunted, inappropriate, or Blunted, inappropriate, or exaggeratedexaggerated

•Flat affect, anhedonia, avolitional, Flat affect, anhedonia, avolitional, vegetativevegetative

•SuicidalSuicidal

Cognitive SymptomsCognitive Symptoms

•Attention disorderAttention disorder

•Loose associationsLoose associations (“knight’s (“knight’s move”)move”)

•Memory impairmentMemory impairment

•Executive functioning – serial, Executive functioning – serial, perseveration, monitoringperseveration, monitoring

Knight’s MoveKnight’s Move

Impaired Theory of MindImpaired Theory of Mind

•Failure to monitor Failure to monitor – what different people can knowwhat different people can know– one’s own intentional actionsone’s own intentional actions– informational needs of othersinformational needs of others– one simply thought somethingone simply thought something– mental and physical distinctionsmental and physical distinctions

Course of Onset (Warning Course of Onset (Warning signs)signs)• <7y: Failure to develop dominant hand early (55% autistics fail <7y: Failure to develop dominant hand early (55% autistics fail

as well)as well)

• 8-12 y: interpersonal problems, poor emotional control, high IQ, 8-12 y: interpersonal problems, poor emotional control, high IQ, sensitivesensitive

• 12-16y: cognitive problems begin, underachievement, 12-16y: cognitive problems begin, underachievement, disorganized thoughts, poor emotional rapport, few friendsdisorganized thoughts, poor emotional rapport, few friends

• 17-20y: [prodomal or precursory] 17-20y: [prodomal or precursory] withdrawalwithdrawal, decreased , decreased grooming, altered school or work performance, delusions grooming, altered school or work performance, delusions emerging, abuse hallucinogens like marijuana or LSDemerging, abuse hallucinogens like marijuana or LSD

Risk of developing Risk of developing schizophrenia in schizophrenia in one’s lifetime one’s lifetime increases as increases as genetic relatedness genetic relatedness with a diagnosed with a diagnosed schizophrenic schizophrenic increases.increases.

Dopamine hypothesisDopamine hypothesis

Genetic ComponentGenetic Component

psychopathology or psychological disorders

Documents

x males

teens2 x

suicide rates

dimensions of depression

heaven of hell

hell of heaven

world rate

mental hygiene arrests