Friday, September 19, 2014 Psychopathology

Butcher JN MIneka S and Hooley JM (2010) abnormal psychology UZ

library
Davison GC and Neal JM (1996) abnormal psychology New York Wiley
(uz library)
Lemma A 1996 introduction to psychopathology London sage
publications uz library
Mash EJ and Wolfe DA 2002 Abnormal Child Psychology Uz library
Pilgrim D Roger A 1999, A sociology of mental Health and illnesses 2 nd
edition University Open Press Buckingham
Psychopathology
1. Demonology
Semi-autonomous/autonomous evil being or devil spirits living
within a person controlling behavior, mind or body.
Ancient Hebrews before Christ and thousands of years later.
Christ is reported to have cured a man with an unclean spirit by
casting out the devil from within him, threw it into the heard of
swine.
The animals then got possessed and ran violently down the hill into
the sea.
Demonological thinking was rampant during that time.
Treatment:
Prayer rituals, forcing the afflicted to drink terrible tasting brews,
flogging or starvation.
Exorcism was another form of treatment.
2. Somatogenesis
Hippocrates (460 -370 BC) regarded as the father of modern
medicine.
He rejected demonology or even that God had control over mental
dispositions of people.
Argued that mental disorders had the same cause as other illnesses
and therefore they should be treated like any other disease.
Regarded the brain as the organ of intellectual life. If thinking and
behavior were deviant then there was some kind of brain pathology.
He was a proponent of somatogenic hypothesis to explain deviant
behavior.
History
They also recognized that something was wrong with the soma and
also recognized that the environment and emotional stress could be
harmful to the body.
Mental disorders were classified into 3 stages:
1. Mania
2. Melancholia
3. Phrenitis (brain fever)
If one is to classify then one has to provide treatment.
For melancholia it equals prescribed tranquility, sobriety as well as
abstinence from sexual activity.
Through his teaching, mental illness became the responsibility of
physicians and not priests.
Hippocrates’ physiology was crude, he conceived normal brain
functioning as dependant on the balance of four humors of the
body:
1. Blood
2. Black bile
3. Yellow bile
4. Phlegm
An imbalance produced disorders.
E.g. if sluggish and dull = too much phlegm; too much black bile =
melancholia; too much yellow bile =irritability; too much blood=
mania (changeable temperament).
Hippocratic somatogenic premise generally was acceptable a few
centuries before and after Christ.
4. Middle ages
3rd century marked the beginning of the dark ages for mental health.
Before that, Hippocratic somatogenic theory spread throughout and
never developed any further. All who believe in it died, Plato,
Aristotle, Galen the Greek and the Roman civilization collapsed as
well as the medical advances and scientific developments.
Christianity started to spread, causes of mental illness reverted to
earlier perspective of demonology i.e. possession by evil spirits, on
the other hand, this perspective was seen as insulting to Christianity.
Thirteen century phenomena of tarantism- hairy spider a form of
possession by foreign forces originated in Italy and spread
throughout Europe a bite by tarantula caused people to run out of
their homes and dance in wild fashions and treatment was
transferred to priests, praying and sprinkling holy water.
Various explanations:
People that were mentally ill were being punished by God for their
sins.
Mental illness seen as personal misfortune.
They had deliberately entering into an agreement with the devil and
therefore were witches endowed with supernatural powers.
The supernatural powers were believed to cause illness to cattle,
ruin crops, male men impotency or had power to turn themselves
into animal.
As a treatment, torture took the place of holy water and torturing
meant to punish satan as well.
5. Period of early medical practices about 1500 AD.
Starts with the continuation of the prevalent view that mentally ill
were witches, hunted by both clergy and members of the public,
brought to trial and then put to death.
Other expressed rational views and one of them was Johann Weyer
16th Century published a book asserting that all witches were
mentally and physically sick people and the book contained good
descriptions of mental illness.
Weyer’s book grew in popularity and is regarded as the founder of
modern psychiatry.
Robert Burton’s book (English scholar, writer and clergyman 1621)
called anatomy of melancholy which was a book that had five
editions between 1621 and 1651.
It was a book that talked of causes, symptoms and cure of
melancholy e.g. viewed child rearing practices as contributing to
adult depression
Benjamin Rush(early 19th century) American physician regarded as
the father of American Psychiatry believed mental illness was caused
by excess blood in the brain and his treatment was drawing excess
blood from the insane.
he also believed that lunatics could be cured by frightening them and
one treatment procedure was then of convincing them that they
were going to die, convincing them if an impending death.
6. Development of asylums
Large numbers of witches housed in dungeons and jails.
Several asylums were established across Europe.
1547 King Henry V111 of England handed over St Mary of Bethlehem
hospital to the confinement of insane and in 1784 there was lunatics
tower in Vienna.
In 1773 in USA there was the first mental hospital founded in
Williamsburg in Virginia.
1793, Philippe Pinel put in charge of a large asylum in Paris known as
LA Bicetre during the French revolution, there were horrific stories in
which the insane were chained to the walls of the cells using iron
collars and not able to lie down during the night thus presumed to
be animals.
Pinel allowed to remove the chains at La Bicetre and started to treat
them as sick human being and some kept in the asylum for years
were being discharged.
Pinel advocated for humanitarian reform in all asylums and
advocated that mental patients be treated with compassion,
understanding and human dignity.
He also advocated that mental health can be restored through
counselling and productive activity i.e. the birth of occupational
therapy.
7. Beginning of contemporary thoughts on mental illness.
Revival of Hippocratic thoughts somatogenic hypothesis in 19 th
century in Europe by a German physician Wilhelm Griesinger insisted
on the physiological cause of mental illness.
Emil Kraepelin wrote a textbook on psychiatry and published in 1883
which provided a classification system of mental illness based on the
organic nature of mental illness.
Recognized a group of symptoms called syndrome, to appear
together on a regular basis and had an underlying physical cause in a
similar way to medical disease.
Regarded each mental illness as distinct from all others and having
its own genesis, symptom, course and outcome (prognosis) despite
the fact that there were no cures yet.
Kraepelin recognized two major groups of mental illness:
1. Dementia praecox (early term of schizophrenia) postulated
chemical imbalance as the cause.
2. Manic depressive Psychosis postulated irregularities in
metabolism
These became the basis for the present day classification of
psychiatric disorders.
Concepts of normal versus abnormal
The definition of abnormal
Abnormal refers to behaviors, emotions or cognitive functions that
are unexpected in their cultural context and they are associated with
personal distress and also associated with substantial impairment in
functioning (DSM 4).
Deviation from social norms
Departure of an individual from society’s unwritten rules i.e. norms
E.g. a man jumping around nude on the streets would be perceived
as abnormal for breaking society norms of wearing clothes.
There are a number of criteria for one to examine before reaching a
judgments as to whether someone has deviated from norms or not
and the first one is culture, what may be seen as normal in our
culture may be seen as abnormal in another.
Second criteria being the situation and context of a behavior e.g.
going to the toilet is a normal act but going in the middle of a
supermarket would be seen as highly abnormal i.e. defecating or
urinating in public is act of indecent public.
The third criteria is age, a child at the age of three could get away
with taking off its clothing in public but not a man at the age of
twenty.
Fourth criteria is gender, a male responding with behavior normally
reacted to as female and vice versa, is retaliated against not just
corrected.
Fifth criteria is historical context, standards of normal behavior
change in some societies, sometimes very rapidly e.g. dreadlocks.
Statistical infrequency
Statistically rare behaviors are called abnormal for example, an
individual above or below average IQ is abnormal is considered
statistically unusual behavior.
At the same time, it is usual to exhibit some form of abnormal
behavior in one’s life.
The failure to function adequately.
An abnormal behavior is that is counter-productive to the individual.
The main problem with this definition however is that psychologists
cannot agree on the boundaries that define what is adequate
functioning.
Deviation from ideal mental health
Mental health is defined as:
1. A state of well-being, in which every individual realizes his or her
own potential and cope with the normal stresses of life, working
productively and fruitfully and is making a contribution to her or
his community.
Health is a state of complete physical, mental and social well-being
and not merely the absence of disease or infirmity. (WHO
Definition).
Definition of abnormality is also determined if the behavior being
displayed is affecting the mental well-being of the exhibitor.
Boundaries that stipulate what “ideal mental health” is are not
properly defined.
Another problem with the definition is that all individuals at some
point in their life deviate from ideal mental health.
But it does not mean they are abnormal e.g. someone who has lost a
relative is distressed but is not defined as abnormal for showing that
particular behavior.
Observer discomfort.
Another proposed criteria of abnormal behavior is observer
discomfort.
A behavior that is, it causing personal or social discomfort to those
who witness it.
Mental illness
The standard criteria in psychology and psychiatry is that there is
mental illness.
Abnormality is based upon medical diagnosis.
Violation of standards of society.
Another criterion suggested is the violation of standards of society.
When people do not follow the conventional social and moral rules
of their society, the behavior is considered abnormal however, the
magnitude of the violation and how commonly it is violated by
others must be taken into consideration.
Multi-criteria approach
A common approach to defining abnormality. All definitions of
abnormality are used to determine whether an individual’s behavior
is abnormal.
For example, if an individual is engaging in a particular behavior that
is preventing them from functioning, breaking a social norm and is
statistically infrequent.
Then psychologists would be prepared to define this individual’s
behavior as abnormal and a good example of an abnormal behavior
assessed by multi-criteria approach is depression:
It is commonly seen as a deviation from ideal mental stability, it
often stops the individual from functioning a normal life, and though
it is a relatively common mental disorder, it is statistically infrequent.
Most people do not experience significant major depressive disorder
in their lifetime.
Friday, September 26, 2014 assessment of psychological disorders.
Clinical assessments
What is a psychological assessment?
Assessment is a procedure in which a clinician/clinical psychologist
evaluates a person in terms of the psychological, social and all other
factors that have the most influence on a person’s functioning
Clinical interview
Interviews are either structured or unstructured or can be a
combination of both.
Interviews are not merely extracting information but two people
trying to understand each other and there is always the use of open
and closed ended questions.
Open questions help elicit more information and allow for more
conversational exchange because there is no single answer to open-
ended questions, one needs to listen, respond and follow the
interviewee’s lead.
Tell me more about the time, about yourself etc…..
Definition: a clinical interview is a tool that that helps physicians,
psychologists, and researchers use to make an accurate diagnosis of
a variety of mental illnesses or psychological problems.
Structured clinical interviews contain standardized questions to
ensure that each patient is interviewed in the same way. These
questions usually ask about the nature, severity and duration of
symptoms.
E.g. of questions.
What are the specific details of your obsessions and compulsions?
How long have you had these obsessions?
How have these affected your life?
Information that is normally gathered is information on: orientation,
presenting problem, current and past behavior, attitudes and
emotions, social and interpersonal history etc.
What is the presenting problem?
Patricia was referred to the crisis center for suicidal thoughts and
suicide attempt which followed an argument with her boyfriend. She
ingested a bottle of prescription pain medication and was admitted
of depression.
Mental state examination
A systematic observation of a person’s behavior and involves
structured interviews.
It is used by clinicians to determine whether or not a psychological
disorder may be present.
Mental state exams cover five general areas:
1. Appearance and behavior
Overt physical behaviors, appearance, body language, facial
expression.
2. Thought processes.
Are thoughts linear and organized?
Are there delusions/hallucinations present?
3. Mood and affect
Mood: condition or attitude experienced for sometimes
characterized by a particular emotion e.g. irritable mood, cheerful
mood.
Affect: refers to the feelings.
Is it appropriate? You feel sad, you look sad.
Euthymic (normal), blunted (minimal variation), and flat affect (no
variation).
4. Intellectual functioning:
Vocabulary and memory testing are used to help determine level of
intellectual functioning.
Repeat these 3 words: pen, flag, and chair.
The serial 7s
Abstracts and metaphors
Proverbs.
5. Sensorium
Clinicians assess a person’s orientation to time, place and person.
Is the person oriented to time?
What year is it?
Where are you?
Who are you?
Psychological testing
Cognitive tests/intelligence testing to gather information for
reaching a diagnosis.
Biological test
Projective tests.
Validity:
Does the assessment measure what it is designed to measure?
Reliability:
Extent to which a test can be replicated and exhibit the same results.
Standardized tests
There are literally hundreds of standardized tests clinicians can use
for assessment purposes:
1. Intelligence/cognitive testing
2. Personality and diagnostic testing
3. Behavioral assessment
4. Biological tests/neuropsychological testing/psychophysiological
testing.
Wechsler scales
Verbal comprehension index: tasks that require a subject to listen to
presented verbal stimuli and provide a verbal response.
Perceptual organizational index: tasks that require a subject to look
at visual stimuli and manipulate them with one’s hands.
Working memory index: tasks that require a subject to listen to
presented information involving numbers, manipulate them in one’s
head then verbalize a response.
Processing speed index: tasks that require a subject to examine
visual stimuli, strategize, perform visual-perceptual discrimination,
and remember the visual stimuli and the rapidly copy symbols or
mark boxes with a pencil.
Intelligent quotient MA/A*100
Deviation IQ.
1. Stanford-Binet test.
2. Wechsler Intelligence tests.
Personality and diagnostic testing
Self-report clinical inventories
These responses yield standardized measures of psychological
symptoms and personality profiles.
Beck Depression Inventory-II (BDI-II).
Minnesota Multiphasic Personality Inventory 2 (MMPI 2).
MMPI 2
Is a self-report measure of overall psychopathology consisting of 567
true/false items giving information about symptoms and
interpersonal relationships and describes different characteristics of
personality consisting of 567 questions answered in 60 to 90
minutes.
Millon clinical Multiaxial inventory III
This is a self-report instrument consisting of 175 items requiring true
or false response and designed to help practitioners assess the
presence of DSM IV axis II disorders as well as a number of other
clinical syndromes such as anxiety, depression, alcohol dependence,
post-traumatic stress disorder and takes approximately 25 minutes
to complete.
Advantages of personality diagnostic and limitations.
Advantages
Same questions to everybody therefore very much standardized.
Limitations
Standardized tools restrict flexibility in the collection of information.
Projective testing
Individual’s interpretations of ambiguous stimuli. They reveal
information about emotional and mental functioning.
Rorschach H (1964) psychodiagnostics
Advantages
They assess client’s deeper and less easily observable emotion and
personality patterns by providing a psychological understanding of
clients.
Limitations.
They are difficult to standardize to.
Neuropsychological testing
Neuropsychologist
A clinical psychologist with a specialty in the applied science of brain-
behaviour relationships.
The neuropsychologist evaluate quantitatively and objectively
cognitive and behavioral functioning.
The neuropsychologist uses this information to identify and diagnose
impairment and plant and implement intervention strategies.
Neuropsychological evaluation
Assessment of cognitive and behavioural functions involve using a
set of standardized tests and procedures that measure: intelligence,
visual-spatial organization, language, information processing, verbal
learning and memory, visual learning and memory, concept
formation, problem solving, planning and reasoning.
When is neuropsychological evaluation needed?
It is recommended for any situation in which brain-based
impairment in cognitive functioning or behaviour is suspected.
Typical referrals include individuals with: traumatic brain injury,
developmental learning disabilities, attention deficit disorders,
strokes, seizure disorders, dementing conditions, effects of toxic
chemicals and chronic substance abuse.
Psychophysiological tests
Psychophysiological assessments measuring changes in the nervous
system that reflect emotional or psychological events e.g. brain
imaging and scanning, Electroencephalogram (EEG), computerized
axial tomography (CAT).
Behavioural assessment
Behavioural assessment puts emphasis on actual behaviour and not
underlying states or traits in personality.
It employs functional analysis, analyses of the stimuli that come
before a specific behaviour and the consequences that follow a
specific behaviour.
Through functional analysis, a therapist can draw conclusions as to
the causes of the behaviour in question and thus better able to treat
it.
Under functional analysis, a clinician is charged with two goals, the
first is to identify the stimulus for behaviour and the conditions that
are present to precipitate it.
The second goal is to determine reinforcements to this behaviour
that causes the individual to continue the behaviour.
In meeting these two goals, the clinician is then able to begin
modifying the behaviour through manipulating the stimuli and or
behaviour.
Behavioural assessment
Formal observation, self-monitoring, behaviour rating scales.
Check out various tools/inventories for behaviour assessment.
Anxiety disorders.
An umbrella term that covers several different forms of a type of
common psychiatric disorder characterized by excessive:
Fear, Rumination, worrying, uneasiness, apprehension either based
on real or imagined events.
Disorder affects both physical and psychological health.
 Overall, anxiety:
 Raises blood pressure and heart rate
 Can cause nausea and vomiting
 Stomach pain, ulcers, diarrhoea
 Tingling, weakness and shortness of breath
 Some other symptoms are self-doubt and self-criticism,
irritability, sleep problems
 And in extreme cases thoughts of wanting to commit suicide.
Classification
 Generalized anxiety disorders (GAD)
 Phobias
 Panic disorder (agoraphobia, social anxiety disorder)
 Obsessive compulsive disorder
 Post-Traumatic Stress disorder (PTSD)
 Separation anxiety
 Situation anxiety
 Childhood Anxiety disorder
GAD generalized anxiety disorder
It is a common chronic disorder characterized by long lasting anxiety
that is not focused on any one object or situation.
A non-specific persistent fear and worry.
It is characterized by chronic excessive worry accompanied by three or
more of the following symptoms:
Restlessness, fatigue, concentration problems, irritability, muscle
tension and sleep disturbance.
GAD is the most common anxiety disorder to affect older adults.
A diagnosis of GAD is made when a person has been excessively
worried about an everyday problem for six months or more.
A person may find they have problems making daily decisions and
remembering daily commitments as a result of lack of concentration,
preoccupation with worry.
Appearance may look strained with increased sweating from hands,
feet and axillae (armpits).
May be tearful which can suggest depression.
Before a diagnosis of anxiety disorder is made, physicians must rule out
drug-induced anxiety and other medical causes.
Phobic disorders
Includes all cases in which fear and anxiety is triggered by a specific
stimulus or situation
Between 5% and 12% of the population worldwide suffer from phobic
disorders.
Sufferers typically anticipate terrifying consequences from meeting the
object of their fear which can be anything: an animal, a location or a
particular situation.
Sufferers understand that their fear is not proportional to the actual
potential danger but still are overwhelmed by the fear.
Panic disorder
Person suffers from brief attacks of intense terror and apprehension
often marked by trembling, shaking, confusion, dizziness, nausea and or
difficulty breathing.
It is a fear or discomfort that abruptly arises and peaks in less than ten
minutes and can last for several hours.
Attacks can be triggered by stress or fear and the specific cause is not
always apparent.
In addition to recurrent unexpected panic attacks, a diagnosis of panic
disorder requires that said attacks have chronic consequences: either
worry over the attacks’ potential implication or persistent fear of future
attacks.
Agoraphobia
It is a specific anxiety about being in a place or situation where escape
is difficult or embarrassing or where help may be unavailable.
Agoraphobia is strongly linked or precipitated by panic disorder.
Agoraphobics need to be in constant view of a door or other escape
routes.
In addition to the fears themselves, the term agoraphobia is often used
to refer to avoidance behaviours that sufferers often develop.
For example, following a panic attack while driving, someone suffering
from agoraphobia may develop anxiety over driving and will therefore
avoid driving. These avoidance behaviours can often have serious
consequences.
Friday, October 3, 2014 Obsessive-compulsive disorders
Obsessive-compulsive disorder (OCD) is a type of anxiety disorder
characterized by:
- Repetitive obsessions {distressing, persistent and intrusive
thought or images}
- Compulsions {an urge to perform specific acts or rituals}
Affects roughly around 3 % of the population worldwide and often the
process is entirely illogical e.g. the compulsion of walking in a certain
pattern may be employed to alleviate the obsession of impending
harm.
And in many cases the compulsion is entirely inexplicable simply an
urge to complete a ritual is triggered by nervousness.
Post-traumatic stress disorder (PTSD)
It is an anxiety disorder which results from a traumatic experience and
can result from an extreme situation e.g.:
- Combat
- Natural disasters
- Rape
- Hostage situations
- Child abuse
- Serious accidents
Common symptoms include:
- Hypervigilance, avoidant behaviours, anxiety, anger and
depression.
Social anxiety disorder (SAD)
Social anxiety disorder can be known as social phobia and is an intense
fear and avoidance of:
- Negative public scrutiny
- Public embarrassment
- Humiliation
- Or social interaction
Fear can be specific to particular social situations e.g. public speaking
SAD is experienced in most social interactions. Social anxiety is shown
by specific physical symptoms:
 - Blushing
- Sweating
- Difficulty in speaking
As with all phobic disorders, those suffering from social anxiety often
will attempt to avoid the source of their anxiety.
Therefore those suffering from social anxiety avoid social interactions
which may lead to complete social isolation.
Situational anxiety disorder
Experiencing panic attacks or extreme anxiety in specific situations and
is caused by new situations or changing events make that particular
individual uncomfortable.
Its occurrence is very common
A situation that causes one individual to experience anxiety may not
affect another individual. E.g. some people may become uneasy in:
- Crowds
- Tight spaces
- Standing in a tightly packed line e.g. queues at the banks.
Childhood anxiety disorders (CAD)
Children and adults experience feelings of anxiety, worry and fear when
facing different situations especially those involving new experiences.
However, if anxiety is no longer temporary and begins to interfere with
the child’s normal functioning or affect their learning it can be
characterized as childhood anxiety disorder (CAD).
It is severe anxiety in children affecting their:
- Thinking, learning and concentration.
- Decision making
 - Perception of the environment
They not only experience fear, nervousness and shyness but also may
start avoiding places and activities.
Causes of anxiety
1. Biological
- Low levels of GABA – Gamma Amino butyric Acid. It is a
neurotransmitter that reduces activity in the central nervous
system.
- Amygdala – part of the brain partly responsible for processing
sensory information related to fear. The function of this organ
appears to be disrupted in people with anxiety disorders.
2. Alcohol abuse
- Severe anxiety and depression can be induced by sustained
alcohol abuse.
- Even moderate sustained alcohol use may increase anxiety and
depression levels in some individuals.
- Anxiety commonly occurs during the acute withdrawal phase of
alcohol.
3. Exposure to organic solvents
- Chronic exposure to organic solvents in the work environment can
be associated with anxiety disorders.
- Painting, varnishing and carpet laying are some of the jobs in
which significant exposure to organic solvents may occur.
4. Life stresses.
- Anxiety disorders can arise in response to life stresses such as
financial worries or chronic physical illness.
5. Dementia
- Anxiety is also common among older people who have dementia.
Treatment
  Anti-anxiety drugs
Benzodiazepines (valium) but very addictive.
 Anti-depressants
 Psychotherapy
 Cognitive behavioural therapy
Affective disorders /mood disorders introduction
- Melancholia from Greek words Melan meaning black – choler
meaning bile which is one of the three types of mental illness
recognized by Hippocrates 4th century BC.
- Late 19th century Emil Kraepelin divided psychosis into two types –
Schizophrenia and Manic depressive illness.
- In all our life we at least experience moments of anxiety but to
the degree that we can be diagnosed as having anxiety disorders.
- In all our life we have moments when we feel sad but not to the
degree that we can be diagnosed as manic-depressives.
Signs and symptoms
- Sad, apathetic mood – {dysphoria} out of proportion to the
person’s life.
- Negative self-concept
- Desire to hide and stay away from others.
- Loss of sleep, appetite and loss of sexual desire.
- Sometimes a tendency to sleep too long – abnormal amount of
sleeping.
- Shift in activity level, either lethargic or agitated.
- Recurrent thoughts of death or suicide.
- Difficulty in concentration.
- Neglect of personal hygiene and appearance.
- Hypochondriacal complaints of aches and pains – no physical
basis.
 - Feel dejected, worthless.
- May also feel anxious and apprehensive.
- All above clinical picture interfere with daily life
- Causes pain for one who is experiencing these symptoms and
family members fell all is not ok.
Types of affective disorders
1. Major depressive disorder or major depression
- The DSM-IV-TR diagnosis of major depressive disorder
- (MDD) requires depressive symptoms to be present for at least 2
weeks.
- Is characterized by a combination of above symptoms
- Symptoms interfere with a person’s ability to work, sleep, study,
eat and enjoy once-pleasurable activities.
- Major depression is disabling and prevents a person from
functioning normally.
- One may experience only a single episode in one’s lifetime and
can also have multiple episodes in one’s lifetimes.
2. Dysthymic disorder or dysthymia
- Is characterized by long term (2 years or longer) symptoms that
may not be severe enough to disable a person.
- Can prevent normal functioning of feeling well
- People with dysthymia may also experience one or more major
episodes of major depression during their lifetimes.
DSM-IV-TR Criteria for Dysthymic Disorder
Depressed mood more than half of the time for two years.
At least two of the following during that time:
● poor appetite or overeating
● sleeping too much or too little
● poor self-esteem
● trouble concentrating or making decisions
● hopelessness
The symptoms do not clear for more than two months at a time.
- No major depressive episode was present during the first two years of symptoms
3. Minor depression
 - Is characterized by having symptoms for 2 weeks or longer that do
not meet full criteria for major depression.
- Without treatment, people with minor depression are at high risk
for developing major depressive major disorder.
4. Psychotic depression
- Which occurs when a person has severe depression plus some
form of psychosis
- Delusions
- Hallucinations.
5. Postpartum depression
- Much more serious than the “baby blues” that many women
experience after giving birth.
- Clinical depression after birth.
6. Bipolar disorder or manic depression
- It is a mental disorder that causes unusual shifts in mood, energy
or activity levels.
- Symptoms of bipolar disorder are severe.
- They are different from the normal ups and downs that everyone
goes through from time to time.
- Bipolar disorder can lead to:
- Breaking up relationships
- Poor job performance
- Poor school performance
- Can lead to suicide
- However bipolar disorders can be treated, people with this illness
can lead full and productive lives.
Signs and symptoms
- People with bipolar disorder experience unusually intense
emotional states that occur in distinct periods called “mood
episodes”.
 - Each mood episode represents a drastic change from a person’s
usual mood and behaviour.
- An overly joyful or overexcited state is called a manic episode and
an extremely sad or hopeless state is called a depressive episode.
- Sometimes a mood episode includes symptoms of both mania and
depression called mixed state
- A mixed state can be explosive and lead into a manic episode or
can degenerate into a depressive episode.
- Extreme changes in energy, activity, sleep and behaviour go along
with these changes in mood.
Manic episode
Mood changes
A long period of feeling high
Happy outgoing mood
Extreme irritability
Behavioural changes
Talking very fast
Jumping from one idea to another
Having racing thoughts
Being easily distracted.
Being overly restless
Sleeping little or not being tired
Behaving impulsively
Engaging in pleasurable high-risk behaviours
Depressive episode
Mood changes
Long periods of feeling sad and hopelessness
Loss of interest in activities once enjoyed including sex.
Behavioural changes
Feeling tired or slowed down
Having problems concentrating, remembering and making decisions.
Being restless or irritable
Changing eating, sleeping or other habits.
Thinking of death or suicide or attempting suicide.
Causes
- Biological causes
Genetics
-Bipolar disorder is among the most heritable of disorders. Much of the evidence for this
comes
From studies of twins.

-Physical brain trauma such as concussion is likely to cause dysthymic disorder.

Chemical imbalance

Neurotransmitters: Three neurotransmitters have been studied the most in

Terms of their possible role in mood disorders: norepinephrine, dopamine, and

Serotonin. Each of these neurotransmitters is present in many different areas of

the brain. Original models suggested that depression would be tied to low levels of
norepinephrine

and dopamine, and mania would be tied to high levels of norepinephrine

and dopamine. Mania and depression were also both posited to be tied to low levels of
serotonin, a neurotransmitter that is believed to help regulate norepinephrine

and dopamine (Thase, Jindal, & Howland, 2002).

- Psychological
PSYCHODYNAMIC THEORIES
Freud hypothesized that after the loss of a loved one—whether by death, separation, or
withdrawal of affection—
the mourner identifies with the lost one—perhaps in a fruitless attempt to undo the loss.
Freud
asserted that the mourner unconsciously resents being deserted and feels anger toward the
loved
one for the loss. In addition, the mourner feels guilt for real or imagined sins against the lost
person.
According to the theory, the mourner’s anger toward the lost one becomes directed inward,
developing
into ongoing self-blame and depression. In this view, depression can be described as anger
turned against oneself. Overly dependent persons are believed to be particularly susceptible
to this
process, and, as noted above, people fixated in the oral stage are overly dependent on
others.

COGNITIVE THEORIES
The most important cognitive theory of depression is that of Aaron Beck (1967).
His thesis is that people develop depression because their thinking is negative (see Figure
8.6).
That is, Beck proposed that depression is associated with the negative triad: negative
views of
the self, the world, and the future. The “world” part of the depressive triad refers to the
person’s
own corner of the world—the situations he or she faces. For example, the person might
think “I cannot possibly cope with all these demands and responsibilities” as opposed to
worrying
about problems in the broader world outside of their life.
According to this model, in childhood, people with depression acquired negative schemata
through experiences such as loss of a parent, the social rejection of peers, or the depressive
attitude
of a parent. Schemata are different from conscious thoughts—they are an underlying set
of beliefs that operate outside of a person’s awareness to shape the way a person makes
sense
of his or her experiences. The negative schema is activated whenever the person
encounters situations
similar to those that originally caused the schema to form.

Treatment
1. Chemotherapy- medication
2. Psychotherapy
- When done in combination with medication, psychotherapy can
be an effective treatment for bipolar disorder.
- It can provide support, education and guidance to people with
bipolar disorder in their families.
- Some types of psychotherapy used to treat bipolar disorders:
 - Cognitive behavioural therapy (CBT) which helps people with
bipolar disorder learn to change harmful or negative thought
patterns and behaviours.
- Family therapy, involves members of the family and helps
improve family coping strategies, improve communication among
family members.

Introduction suicide
- 1 million people across the globe die by suicide each year.
- More people die by suicide each year than by murder and war
combined.
- It’s estimated that approximately 5% of people that attempt
suicide at least once in their life.
- Between ten to 14% of the general population have suicidal
thinking throughout their lifetime.
Causes
Depressive disorder
- The most common reason people commit suicide. Severe
depression is always accompanied by a pervasive sense of
suffering as well as the belief that escape from it is hopeless.
- The pain of existence often becomes too much for severely
depressed people to bear
- The state of depression overcomes logical thinking allowing ideas
like everyone will be better off without me to make rational
sense.
- If you suspect someone might be depressed there is the
possibility of suicidal ideation.
Psychosis
 - Hallucinations often command self-destruction for unintelligible
reasons.
- Psychosis is much harder to mask than depression and is arguably
even more tragic
- The worldwide incidence of schizophrenia is 1%.
- And often strikes healthy high-performing individuals.
- Although their lives is manageable with medication, they never
fulfill their full potential.
- Schizophrenics more likely to talk freely about the voices
commanding them to kill themselves.
- Give honest answers about thought of suicide when asked
directly, compared with depressives.
Impulsive behaviour
- Often related to drugs and alcohol abuse.
Cry out for help
- Don’t know how else to get it.
- These people don’t usually want to die.
- Want to alert those around them that something is seriously
wrong.
- They often don’t believe they will die.
- Frequently choosing methods they don’t think can kill them.
- Want to strike out at someone who’s hurt them.
- But they are sometimes tragically misinformed, can attempt a
method of suicide that turns out to be tragic.
They have a philosophical desire to die.
- Reason decision often motivated by the presence of a painful
terminal illness from which little to no hope of recovery exists.
- These people aren’t depressed, psychotic or crying out for help.
- They are trying to take control of their destiny and alleviate their
own suffering which usually can only be done in death.
- Often look at their choice to commit suicide as a way to shorten a
dying that will happen at some time.
- They’ve made a mistake
- Tragic phenomenon in which typically young people play around
with something terribly dangerous e.g. guns.
Friday, October 17, 2014 Schizophrenia
Introduction
This is a chronic, severe and disabling mental disorder which affects
people throughout history.
People with this disorder may hear voices other people don’t hear
(hallucinations).
They may believer:
- Other people are reading their minds
- Controlling their thoughts
- Or plotting to harm them
They may sit for hours without talking or moving and what they
speak or say may not make sense.
When quiet they may seem perfectly normal and families tend to be
affected by schizophrenia too.
Patients have difficult holding jobs or caring doe themselves so rely
on others for survival.
Treatment is available to relieve symptoms and without medications
they relapse.
Most people with this disorder cope with symptoms throughout
their lives with medication.
Symptoms
Psychotic symptoms losing touch with reality.
- Symptoms come and go.
- Sometimes they are severe and at times hardly noticeable
depending on whether the individual is receiving treatment.
- They include the following:
a. Hallucinations which are things a person sees, hears, smells, feels
that no one else can.
Voices are the most common type of hallucinations that is many
people with schizophrenia hear voices.
The voices may talk to the person about his or her behaviour,
ordering the person to do things, warnings about danger and
sometimes the voices talk to each other.
People with schizophrenia may hear voices for a long time before
family and friends notice the problem.
Other hallucination problems include:
- Seeing people ore objects that aren’t there.
- Smelling odors that no one else detects.
- Feeling things like invisible fingers touching them when no one is
near.
b. Delusions are false beliefs that are not part of the person’s
culture and these beliefs do not change even if others prove that
they are false or illogical.
People with schizophrenia can have delusions that seem bizarre
such as believing that neighbours can control their behaviour with
magnetic waves.
 They may also believe that television personalities are directing
special messages to them or that radio stations are broadcasting
their thoughts aloud to others.
Sometimes they believe that they are someone else usually
famous historical figures and may have paranoid delusions:
- Believe that others are trying to harm them
- Others are cheating them
- Others are harassing them
- Others are poisoning them or spying on or plotting against them
which is also referred to as delusions of persecution
c. Thought disorders
This are unusual or dysfunctional ways of thinking.
Forms of thought disorders
i. Disorganized thinking
This is when the person has trouble organizing his or her thoughts
or connecting them logically.
They may talk in a garbled way that is hard to understand.
ii. Thought blocking
This is when a person stops speaking abruptly in the middle of a
thought. When asked why they stopped, they may say that they
felt as if the thought had been taken out of their head.
iii. Neologism
This is the making up of meaningless words.
Cognitive symptoms – poor intellectual functioning.
d. Movement disorders.
 They may repeat a certain motion(s) over and over again. On the
extreme, they may become catatonic, state in which a person does
not move and respond to others.
Catatonic schizophrenia
It is rare today but it was more common when schizophrenia
treatment was not available.
Causes
A combination of genetic and environmental factors. People with a
family history of schizophrenia are more vulnerable.
Estimates of heritability vary because of the difficulty in separating
the effects of genetics and the environment.
The greatest risk for developing schizophrenia is having a first degree
relative with the disease.
A child of 2 parents with schizophrenia has 46% chance of
developing the disorder.
Environmental factors.
- Drug abuse
- Parental style (people with supportive parents do better than
those with critical or hostile parents)
- Social isolation, social adversity
- Family dysfunctions
- Unemployment
Substance abuse
Marijuana ,
Alcohol dependence
 Alcoholism
It is a broad term for problems with alcohol and is generally used to
mean:
- Compulsive and uncontrolled consumption usually to the
detriment of the drinker’s health, personal relationships and
social standing.
It is medically considered a disease, specifically an addictive illness
and in psychiatry several other terms are used specifically – alcohol
abuse, alcohol dependence, alcohol use disorder.
Alcohol is a large group of organic compounds derived from
hydrocarbons and containing one or two hydroxyl (OH) groups.
Ethanol C2H50H ethyl alcohol is one of this class of compounds and is
the main psychoactive ingredient in alcoholic beverages.
Ethanol results from the fermentation of sugar and yeast. Beverages
produced by fermentation have an alcohol concentration of no more
than 14%.
Apart from its use for human consumption, it is a fuel solvent and in
chemical manufacturing of various chemicals.
Alcoholism is characterized by:
- Increased tolerance of alcohol
- Physical dependence on alcohol
- Above characteristics affect an individual’s ability to control
alcohol consumption.
According to NIAAA –national institute on alcohol abuse and
alcoholism:
 - Men may be at risk for alcohol-related problems if their alcohol
consumption exceeds 14 standard drinks per week or 4 drinks per
day.
- Women may be at risk if they have more than 7 drinks per week
or 3 drinks per day.
- A standard drink is defined as one 12 ounce bottle of beer, one 5
ounce of glass of wine or 1.5 ounces on distilled spirits.
Long term effects
Physical symptoms
- Cirrhosis of the liver, pancreatitis, epilepsy, alcoholic dementia,
cardiovascular diseases, peptic ulcers, sexual dysfunction.
- Woman can develop long-term complications of alcohol
dependence more rapidly than men.
- Additionally women have a higher mortality rate from alcoholism
than men.
- Fetal alcohol syndrome – physical abnormalities and the
impairment of mental development in children of alcoholic
mothers.
Psychological effects
Long term misuse can cause a wide range of mental health problems,
dementia.
Psychiatric disorders are common in alcoholics with as many as 25
percent suffering severe psychiatric disturbances.
Most prevalent psychiatric symptoms are anxiety and depression which
worsen during alcohol withdrawal but typically improve or disappear
with continued abstinence.
- Psychosis, schizophrenia, panic disorder and dementia.
Social effects.
These are very serious and caused by pathological changes in the brain
and the intoxicating effects of alcohol.
Alcohol abuse is associated with an increased risk of committing
criminal offenses.
Child abuse, domestic abuse, violence, abuse, assault, loss of
employment, criminal charges are all associated to drunken driving.
Other effects include isolation from family and friends, marital conflicts,
divorce.
Alcohol withdrawal
Sudden withdrawal can be fatal if not properly managed. Alcohol’s
primary effect is the increase in the stimulation of GABA receptors
promoting CNS depression.
With repeated heavy consumption, these receptors are desensitized
resulting in tolerance and physical dependence. When alcohol
consumption is stopped too abruptly, the person’s nervous system
suffers from uncontrolled synapse firing and this can result in
symptoms like:
- Anxiety, seizures, delirium tremens, hallucination, heart failure.
Delirium Tremens (DTS)
This is an acute psychotic state occurring during withdrawal phase in
alcohol-dependent individuals.
It is characterized by confusion, disorientation, paranoid ideation,
delusions, illusions, hallucinations typically visual or tactile,
restlessness, tremor sweating.
Onset of delirium tremens is usually 48 hours or more after cessation or
reduction of alcohol consumption and may be present up to one week
from time of onset.
Progression to alcoholism
In the classical disease model, alcoholism follows a progressive course,
if a person continues to drink their condition will worsen.
Johnson (1980) explores the emotional progression of the addicts’
response to alcohol and looks at four main stages/phases.
The first 2 are considered normal drinking and the last 2- typical alcohol
drinking and these four phases consist of:
1. Learning the mood swing – a person is introduced to alcohol in
some cultures this happens at relatively young ages and the
person enjoys the happy feeling it produces.
2. Seeking the mood swing – a person will drink to regain that
feeling of euphoria experienced in phase 1, drinking will increase
as more intoxication is required to achieve the same effect.
3. Physical and social consequences – i.e. hangovers, family
problems, work problems etc. a person will continue to drink
excessively disregarding the problems.
4. This stage can be detrimental. A person now drinks to fell normal
– the block out of the feelings of overwhelming guilt, remorse,
anxiety and shame they experience when sober.
Management/treatment
Treatments are varied because there are multiple perspectives of
alcoholism.
Those who approach it as a medical condition recommend medical
treatment e.g. detoxification i.e. drying out.
Most treatments focus on helping people discontinue their alcohol
intake followed up with life training or social support in order to help
them resist a return to alcohol use.
Fetal alcohol syndrome
FAS results in a child that is exposed to alcohol during mother’s
pregnancy.
FAS causes brain damage and growth problems which are irreversible.
There is no amount of alcohol that is known to be safe to consume
during pregnancy.
If you suspect FAS in a child talk to doctors as soon as possible, early
diagnosis may reduce the risk of problems such as learning difficulties
and behavioural issues.
Signs and symptoms
- Physical defects
- Intellectual/cognitive disabilities
- Problems of functioning and coping with day to day lie
- FAS facial characteristics – small eye opening, smooth philtrum
nose, thin upper lip.
- Cognitive problems- attention, poor memory, slow processing,
hyperactive, mood swings
- Social problems – difficulty in school, poor social skills, difficulty
making friends, behavioural impairment.
Tobacco
Tobacco use is responsible for premature deaths, one in every five
deaths in USA.
For every one person who dies from smoking, 20 more suffer from at
least one serious tobacco related illness.
The harmful effects of smoking extend far beyond the smoker.
Exposure to second hand smoke can cause serious disease and
death.
Cigarettes and other forms of tobacco including cigars, pipe tobacco,
snuff and chewing tobacco contain the addictive drug nicotine.
Nicotine is readily absorbed into the bloodstream when a tobacco
product is chewed, inhaled or smoked.
Upon entering the bloodstream, nicotine immediately stimulates the
adrenal glands to release the hormone epinephrine (adrenaline).
Epinephrine stimulates the CNS and increases blood pressure
respiration and heart rate.
Like cocaine, heroin and marijuana, nicotine increases the level of
the neurotransmitter dopamine which affects the brain pathways
that control reward and pleasure.
Long term brain changes induced by continued nicotine exposure
results in addiction.
Additional compounds in tobacco smoke such as acetaldehyde
enhance nicotine’s effects on the brain.
When an addicted person tries to quit he or she experiences
withdrawal symptoms:
- Irritability, attention difficulties
- Sleep disturbances, increased appetite
- Powerful cravings for tobacco.
Treatments can help smokers manage these symptoms and improve
the likelihood of successfully quitting.
Cigarette smoking accounts for about one third of all cancers:
- Including 905 of lung cancer cases
- Smokeless tobacco such as chewing tobacco and snuff also
increase the risk of oral cancer.
In addition to cancer, smoking causes:
- Lung diseases, chronic bronchitis and emphysema
- Increases the risk of heart disease including stroke, heart attack,
vascular disease and aneurysm.
- Smoking has also been linked to leukemia, cataracts and
pneumonia.
Adverse effects
Although nicotine is addictive and can be toxic if ingested in high
doses, it does not cause cancer.
Other chemicals are responsible for the most severe health
consequences of tobacco use.
Tobacco smoke is a complex mixture of chemicals:
- Carbon monoxide, tar, formaldehyde, cyanide and ammonia many
of which are known carcinogens.
- Carbon monoxide increases the chance of cardiovascular diseases.
- Tar exposes the user to an increased risk of lung cancer,
emphysema and bronchial disorders.
Pregnant women who smoke cigarettes run an increased risk of
miscarriage, stillborn, premature infants or infants with low birth
weight.
Maternal smoking may also be associate with learning and
behavioural problems in children.
Treatment
Medication
Tobacco addiction is a chronic disease that often requires multiple
attempts to quit.
Although some smokers are able to quit without help, many others
need assistance.
Both behavioural interventions and medication can help smokers
quit but the combination of medication with counselling is more
effective than either alone.
Behavioural treatments
Behavioural treatments employ a variety of methods to assist
smokers in quitting ranging from self-help materials to individual
counselling.
These interventions teach individuals to recognize high-risk
situations and develop coping strategies to deal with them.
Nicotine replacement therapies NRT
Nicotine replacement therapies include nicotine chewing gum, the
nicotine transdermal patch, nasal sprays, inhalers and lozenges.
NRTs deliver a controlled dose of nicotine to a smoker in order to
relieve withdrawal symptoms during the smoking cessation process.
They are most successful when used in combination with
behavioural treatments.
Cocaine
It is a powerfully addictive stimulant drug made from the leaves of
the coca plant native to South America.
It produces short-term euphoria, energy and talkativeness- in
relation to potentially dangerous physical effects like raising heart
rate and blood pressure.
The powdered form of cocaine is either inhaled through the nose
(snorted) or dissolve in water and injected into the blood stream.
Crack is a form of cocaine that has been processed to make a rock
crystal also called freebase cocaine that can be smoked.
The crystal is heated to produce vapors that are absorbed into the
blood stream through the lungs. The term crack refers to the
crackling sound produced by the rock as it is heated.
Effects on brain
It is a stimulant that increases the levels of dopamine on the brain
and is very addictive.
With repeated use tolerance develops, users increase their dose in
an attempt to intensify and prolong their high but this increase in
doses also increases the risk of adverse psychological or
physiological effects.
It constricts the blood vessels, dilates the pupils, and increases the
body temperature, heart rate and blood pressure. It can also cause
headaches, abdominal pain and nausea.
Because cocaine tends to decrease appetite, chronic users can
become malnourished as well.
Users can suffer heart attacks or strokes. Cocaine related deaths are
often a result of cardiac arrest (heart stopping).
People who use cocaine also put themselves at risk for contracting
HIV due to sharing of needles or impairment of judgement resulting
in risky sexual behaviour and some effects of cocaine depend on the
method of taking it.
Regular snorting of cocaine:
- Leads to loss of the sense of smell, nosebleeds, problems with
swallowing, hoarseness and a chronically runny nose.
- Ingesting cocaine by the mouth can cause severe bowel gangrene
as a result of reduced blood flow.
Heroin
It is an opioid drug that is synthesized from morphine a naturally
occurring substance extracted from the seed pod of the Asian opium
poppy plant.
Heroin usually appears as a white or brown powder or as a black
sticky substance known as black tar heroin.
Use
Heroin can be injected, inhaled by snorting or sniffing or smoked.
When it enters the brain, heroin is converted back into morphine
which binds to molecules on cells known as opioid receptors.
These receptors areas located in areas of the brain especially those
involved in the reception of pain
Marijuana
It is a dry shredded green and brown mix of leaves, flowers, stem
and seeds from the hemp plant cannabis sativa.