psychological disorders. schizophrenia literal translation ‘split mind’ the most crippling of...

Psychological Disorders

Schizophrenia

• Literal translation ‘split mind’

• The most crippling of the psychiatric disorders

• Costs more than all the cancers combined

Nobel Prize Winner John

Nash

Subtypes of Schizophrenia

• Paranoid• Disorganized• Catatonic• Undifferentiated

  Symptoms include:

Disorders of:• thought (e.g., delusions & paranoia)• language (e.g., incoherence, rhyming speech)• perception (e.g., especially auditory hallucinations

– 70% of schizophrenics report hearing voices)• blunted or inappropriate emotions• strange or odd behaviors (e.g., facial grimaces)

Schizophrenia

• Positive symptoms– Hallucinations– delusions – disorganized speech/behavior

• Negative symptoms– Isolation– Withdrawal– Apathy– Blunted Emotional Expression

• Negative symptoms are less influenced by medications than positive symptoms

What Causes Schizophrenia?

• Genetic• Environmental • Chemical/Biological• Brain abnormalities

Genetic Influences on Schizophrenia

Lifetime riskof developingschizophrenia

for relatives of a schizophrenic

40

30

20

10

0 Generalpopulation

Siblings Children Fraternaltwin

Childrenof two

schizophrenia victims

Identicaltwin

Environmental Factors• Identical twins don’t show 100% concordance, so

there must be an environmental component.• Stress triggers potential risk & can make it worse (but

is hard to measure)• Persons born in winter are more likely to develop

schizophrenia (but only in Northern climates)• In years of influenza epidemics, babies born 3 months

later are at increased risk for schizophrenia (diagnosed 20 years later)

• Suggests one potential stressor is pre-natal

Biological basesEvidence from• brain scans • studies using antipsychotic drugs• drugs decreasing dopamine activity in brain reduce

severity• drugs increasing dopamine in brain (e.g., L-dopa) can

produce schizophrenic-like conditions

• dopamine hypothesis: underlying cause of schizophrenia is excessive stimulation of certain types of dopamine synapses

Could you fool a psychologist into thinking that you are mad?

Probably!!

Experiment: David Rosenhan (1973)

After admission, behaved normally & no longer complained of auditory hallucinations

All were admitted and diagnosed as paranoid schizophrenic (+ 1 manic depressive)

Went to psychiatric hospitals & complained of 1 symptom:• Heard voices: “empty” “dull” & “thud”• Faked names & occupations• Otherwise, honest about personal histories

Perfectly normal behavior interpreted as consistent with the idea they were abnormal

Their Question: “At what point would someone detect their sanity?”

The Answer: “it never happened” (20 hospitals)

Even after study, hospitals persisted, releasing the pseudo-patients with a diagnosis of “schizophrenia in remission”.

Rosenhan took notes – described as “writing behavior”

Patient said: “had a close relationship with his mother but was rather remote from his father during his early childhood. During adolescence and beyond however his father became a close friend while his relationship with his mother cooled. His present relationship with his wife was characteristically close and warm. Apart from occasional angry exchanges, friction was minimal, the children had rarely been spanked.” Clinician “explained”: “This white 39-year old male manifests a long history of considerable ambivalence in close relationships, which begins in early childhood. A warm relationship with his mother cools during adolescence. A distant relationship to his father is described as becoming very intense. Affective stability is absent. His attempts to control emotionality with his wife and children are punctuated by angry outbursts and in the case of the children, spankings. An while he says that he has several good friends, one senses considerable ambivalence embedded in those relationships also.”

Dissociative Identity Disorder

• Formerly called Multiple Personality Disorder – The presence of 2 or more distinct identities or

personality states that recurrently take control of behavior.

– Each personality has its own memories, behavior patterns and social relations

– Misconception:• schizophrenia = having multiple personalities

Dissociative Identity Disorder

• Identities may have contrasting personalities which may emerge in certain circumstances and may differ in reported age and gender, vocabulary use, general attitude and predominant affect.

• Time to switch between identities is usually only a matter of seconds and often accompanied by visible changes.

Thought experiment

• What are 3 of your biggest fears?

– Specific phobia types in DSM-IV

• Animal type (snakes, spiders)

• Natural environment type (heights, storms)

• Blood-injection-injury (BII) type (seeing blood, getting a shot, watching surgery)

• Situational type (enclosed spaces, bridges)

• Other (vomiting, loud sounds, clowns)

Specific Phobias

Coulrophobia

More Phobias• Myrmecophobia- ants• Phalacrophobia- becoming bald• Hobophobia-bums or beggars• Acrophobia-heights• Pentheraphobia- mother-in-law• Hypengyophobia-responsibility• Venustraphobia- beautiful women• Ailurophobia-cats• Gamophobia- marriage • Ophidiophobia-snakes • Arachnophobia-spiders • Hydrophobia- water

Adaptations to Predators and Environmental Dangers:

Fears and Phobias • Fears: snakes, spiders,

heights, separation, darkness, strangers

• Responses: freeze, flee, fight, submit

• Developmental timing of onset of fears: coincides with adaptive problems

Watch Clips on Phobias

Mood Disorders

• Major Depressive Disorder (Unipolar Depression)

• Bipolar Disorder (Manic Depressive Disorder)

Depression• ‘Common cold’ of mental illness• 17% lifetime prevalence• Twice as common among women as men

– Bias in diagnosis?– Self-medicating

• Depression much more common among people born after mid-20th century (up to 3 times higher)

Depression

• Characteristics– Persistent sadness, gloom– Hopelessness, guilt, worthlessness– Decreased energy, marked changes in

sleeping/eating – Difficulty concentrating, restlessness

Depression

• Environmental factors– ¾ of recently depressed individuals

experienced preceding negative life event– However, only 1 in 5 experiencing

negative life event develop depression

Depression

• Cognitive features– Negative view of themselves, the world,

and the future (cognitive triad)– Attention turned inward (rather than

outward)

Depression• Important Risk factors

– Low social support– Low self-esteem– Ruminative response style– Physical/emotional illness– Previous episode of depression– Heredity

Depression

1Stressful

experiences

4Cognitive and

behavioral changes

2Negative

explanatory style

3Depressed

mood

The vicious cycle of

depression

Mood Disorders

• Bipolar Disorder (Manic Depression)– Characterized by dramatic mood swings—from

overly "high" and/or irritable to sad and hopeless, and then back again, often with periods of normal mood in between

• Depressive episode: usual symptoms of depression• Manic episode

• Increasing rates of teen suicide• 1% prevalence

Bipolar Disorder

• "Manic-depression distorts moods and thoughts, incites dreadful behaviors, destroys the basis of rational thought, and too often erodes the desire and will to live. It is an illness that is biological in its origins, yet one that feels psychological in the experience of it; an illness that is unique in conferring advantage and pleasure, yet one that brings in its wake almost unendurable suffering and, not infrequently, suicide. “

-- Kay Redfield Jamison, Ph.D., An Unquiet Mind, 1995

Bipolar Disorder

• Approximately 1 in 5 die from suicide

• Highly heritable– 70% concordance rate for MZ

twins, 20% for DZ

• PET scan of bipolar brain

Depressed state Manic state Depressed state

Bipolar Disorder