Emotional Health
Emotional/Mental Dysfunction, Disorders
Emotional Health
O Crisis Clinic, King County
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24-hour phone line: 866 4CRISIS (866-427-4747)
Local: 206-461-3222
TDD line: 206-461-3219
Chat also available
155 languages
O Outside of King County, call 911 or National Suicide
Prevention Lifeline:1-800-273-TALK
O King County Health & Human Services Community
Information
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2-1-1
206-461-3200/800-621-4636
TDD: 206-461-3610
Teen Link: 866-833-6546
What is Emotional /Mental
Health?
O Accurate perception of reality
O Adaptation to change
O Ability to cope
O Ability to think in organized manner
O Ability to assess one’s own behavior
Emotional/Mental Disorders
O General
classifications
O Diagnostic
classifications
General Classifications
O Neurosis
O Psychosis
Neurosis
O Emotional disorder caused by
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unresolved conflicts, leads to anxiety
A neurotic person can grasp reality
A neurotic person has irrational
thoughts
Behavior may not make sense
A neurotic person is aware of irrational
thoughts, behaviors, but has problems
fixing them
Neurosis
O Pop culture example #1 –
George Costanza
O Pop culture example #2 –
Sheldon Cooper
O Pop culture example #3 – Alvy
Singer
O Pop culture example #4 – Annie
Walker (obscenities)
Psychosis
O Sense of reality is distorted
O Hallucinations: hearing/seeing something
that does not exist
O Delusions: Irrational beliefs not based on
reality
O Extremely disorganized thinking
O Personality changes
Psychosis
O Example: Center for Addiction and Mental
Health video
O Michael (PBS News Hour, 0-1:43)
O Dennis Allard interviews his brother, Tony
(YouTube; previously private video – may
not be accessible)
Diagnostic Classifications
O Diagnostic and Statistical Manual of
Mental Disorders (DSM-V) published in
2013
O Many categories of disorders, as well
as individual disorders:
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Anxiety disorders
Obsessive-compulsive disorder
Post-traumatic stress disorder
Mood disorders
Schizophrenia
Anxiety Disorders, ObsessiveCompulsive Disorder, PostTraumatic Stress Disorder
Anxiety Disorders
O Characterized by feelings:
O Apprehension
O Fear
O Alarm
O Terror
O Anxiety occurs in situation where average
individual is unaffected
Anxiety Disorders Resources
O General Information: Anxiety Disorders
Association of America
O Therapist lookup
O Free webinars with registration
O Anxiety Thursdays (fee = $75 for group
or $300 for six; OCD, panic disorder,
social anxiety, trichotillomania)
O Info: 206-285-0900;
dkosins@u.washington.edu
O http://davidkosins.com
O Place: 318 W. Galer St., Suite #201
Generalized Anxiety Disorder
O Vague feeling of worry or dread
O Job, family, home, health, etc.
O A feeling that something is wrong
O Worry is out of control
O Characterized by: fatigue, restlessness, irritability,
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difficulty concentrating, muscle tension, sleep
disturbances
Occurs for at least six months
Experienced distress is significant
Video Clip (Anxiety Disorders Manitoba, 0:53 to 2:36)
Video Clip (Stories of Hope and Courage documentary clip)
Video Clip (Dr. Rami Nader, via YouTube, ~56 minutes)
Treatment: cognitive behavioral therapy,
medication
Specific(Simple) Phobia
O Fear is focused on particular
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object/situation
Anxiety is out of proportion to situation
Example: claustrophobia; others?
Distress interferes with life
Duration at least six months
Video: phobia of dogs (Animal Planet, ~3:00)
O Video clip #1 (short); Video clip #2 (longer;
4:28)
O Treatment: cognitive behavioral therapy,
medication
Panic Disorder
O Panic attacks are recurrent, expected or
unexpected
O Panic attack symptoms: four or more of the
following
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Increased heart rate
Increased breathing frequency
Sweating
Trembling
Chest pain/discomfort
Nausea
Dizziness
Fear of dying/losing control, feelings of detachment
Attacks not due to chemical substance
O Fear of having unexpected panic attacks
Panic Disorder
O Used to be distinguished as with or without
agoraphobia
O Agoraphobia
O Anxiety over situations/places where escape is
difficult or even embarrassing
O Usually situations outside the home
O The situations are avoided or endured with
extreme discomfort
O Video Clip, Colin’s Story (NHS Choices, ~3:00)
O Agoraphobia now a separate disorder
O Treatment: cognitive behavioral therapy,
medication
Obsessive-Compulsive Disorder
O In 2013, DSM-V recognized OCD as
its own disorder (formerly an Anxiety
Disorder)
O Obsession
O Recurrent, persistent thought, impulse or
image experienced as inappropriate,
marked by anxiety
O Thought, impulse, image not about real-life
problems
O Person attempts to ignore/suppress
O Individual recognizes irrationality
Common Obsessions
O Need for order,
organization,
exactness
O Concern over
contamination
O Fear of evil thoughts
O Fear of doing harm
to self or others
Obsessive-Compulsive Disorder
O Compulsion
O Repetitive behaviors/actions relating to
obsession
O Behaviors/actions aimed at reducing
anxiety
Common Compulsions
O Counting to a
specific number
O Arranging objects in
specific ways
O Cleaning, bathing
O Seeking of
reassurance
O Behavior repetition
Video Clips
O Pop culture
(thru 1:20)
O Real life
O Real life
2:34)
(National Geographic,
Obsessive-Compulsive Disorder
O Obsession/Compulsion
O Person may or may not recognize
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obsessions/compulsions are
unreasonable
Obsessions/compulsions cause significant
distress
Not due to chemical substance
Yale-Brown Obsessive-Compulsive Scale
Obsessive-Compulsive Disorder
Screening Quiz (PsychCentral.com)
OCD Treatment, Resources
O Treatment: medication, cognitive-behavior
therapy
O More serious cases:
O Gamma knife surgery (some researchers have
found brain cysts as long-term side effect)
O Deep brain stimulation
O Animation (Medtronic, Westymedia, via
YouTube, thru 1:35)
O Real life story (Aljazeera America)
O Support meetings & potlucks at Swedish
Hospital (747 Broadway), 3rd Saturdays,
10am-1pm, cafeteria alcoves
Post-Traumatic Stress Disorder
O In 2013, DSM-V recognized PTSD as a
“Trauma- and Stressor-Related Disorder”
(formerly an Anxiety Disorder)
O Person exposed to an event threatening
injury or death to self/others (examples)
O Event re-experienced
O Images/thoughts/perceptions
O Dreams
O Intense reactivity to cues or symbols of event
O Example (0:40-5:09; disturbing clip)
Post-Traumatic Stress Disorder
O Avoidance of triggers, reduced
responsiveness
O Thoughts, feelings, conversations
O Activities, places, people associated
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with trauma
Inability to recall an aspect of the
trauma
Reduced participation in activities
Feeling of detachment
Sense of shortened future
Post-Traumatic Stress Disorder
O Treatments
O Cognitive therapy
O Desensitization
O Eye Movement
Desensitization and
Reprocessing video
O Group therapy
O Anti-depressants
O Marijuana:
O Approved in WA state
O January 2016 not in NY
O Continued research
Post-Traumatic Stress Disorder
O Persistent symptoms
O Sleep difficulties
O Irritability
O Concentration difficulties
O Exaggerated startle response
O Significant distress
O Occurs for longer than a month
PTSD Resources
O WA State Department of Veterans
Affairs PTSD Program: 800-562-2308
O Crisis Hotline: 800-273-TALK
O VA Puget Sound Healthcare: 206-762-1010
(Seattle), 253-582-8440 (Tacoma)
O PTSD Newsletter (via Yahoo groups)
O Search for therapists via Psychology
Today
O Anxiety & Stress Reduction Center of
Seattle
Name That Disorder
O Jimmy experiences intense fear whenever
he is in, or even near, a plane. Which
anxiety disorder BEST describes the
scenario?
Name That Disorder
O Mike is insistent on straightening
everything in his apartment. For example,
towels must be folded in a specific
manner and placed on a towel bar so that
ends of towels are even with each other.
Furniture is symmetrically organized
around the room to ensure balance.
Name That Disorder
O Julia experiences nightmares after she is
robbed at gunpoint. She is unable to
concentrate, not doing well in school, and
making errors at work.
Schizophrenia
Schizophrenia
O A “psychotic disorder”
O Severe disturbances in perception,
thought, mood, behavior, or a combination
O Affects ~1% of population
O Affects individuals around the globe (slate.com,
2:12)
Schizophrenia
O Characterized by:
O Positive Symptoms (should not be
present)
O Delusions
O Hallucinations
O Disorganized speech
O William (Learner.org excerpt via YouTube)
O Example: clang association/clanging
O Disorganized or catatonic behavior
Schizophrenia
O Also characterized by:
O Negative symptoms (something is
missing)
O Flat affect
O Poor rapport
O Difficulty with abstract thinking
O Lack of self-care
Schizophrenia
O Work, social relations, self-care are
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significantly affected
Minor physical anomalies: wide-set
eyes, ear malformations, curved fifth
finger, visible blood vessels in nailbeds
(children)
Signs occur for at least six months, at
least one month of active signs
Disturbance not due to chemical
substance
Change in DSM-V: “Schizophrenia
Spectrum” & Other Psychotic Disorders
Schizophrenia Profiles
O Maurizio Baldini
(MentalHealth.com,
story)
O Gerald
(YouTube; first 3 minutes of
8)
(YouTube; 5:30)
O Four Stories (YouTube: 0:24-2:00,
4:38-7:11)
O Heather
Schizophrenia Symptom:
Catatonic Behavior
O Caveat: catatonia also its own disorder
O Abnormalities in speech, senses, movements
O Video clip (YouTube)
O Excessive, sometimes violent motor activity;
or mute, unmoving, stuporous
O Echolalia
O Example in autism (YouTube)
O Echopraxia
O Example from film footage (YouTube)
O More examples (NLMNIH, via YouTube; 11:33)
Schizophrenia Symptom:
Disorganized Speech, Behavior
O Incoherent speech
O Disorganized behavior
O Flat or inappropriate emotional response
O Peter (YouTube; ~2:35 of 3:35)
Schizophrenia Symptoms:
Hallucinations, Delusions
O Hallucination: a false sensory experience
O Often, auditory hallucinations the most
prominent
O Anderson Cooper exercise, (CNN, 2014)
O Auditory hallucinations (YouTube)
O Delusion: a false belief
O Hallucinations and delusions are created
by mind vs. external stimuli
O One or more delusions
O Persecution, grandeur
Schizophrenia Profiles
O 9-year old Rebecca (ABC News)
O Linda Carmella Sibio
O Louis Wain’s disease progression (or
here)
O ABC 20/20 Program from 2000 (6:04)
O Girogianna (via YouTube)
Possible Causes
O Genetics
O Environment
O Brain abnormalities
O Neurotransmitter hypothesis
Schizophrenia and Genetics
O There is no one gene associated with
schizophrenia
O Genes to Cognition chromosome map
O Schizophrenia’s Genetics Revealed
(University of Queensland, via YouTube)
O Heredity and schizophrenia
(schizophrenia.com)
O Genetic predisposition may not be enough
Schizophrenia and
Environment
O Prenatal care, including nutrition (Vitamin D),
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influenza vaccination
Complications at birth (newborn breathing
issues, maternal hypertension, others)
Exposure to virus during pregnancy
Relationship between schizophrenia and
poverty
O Do complications inherent in poverty
increase likelihood for getting
schizophrenia, or
O Does poverty result because an individual
diagnosed with schizophrenia is impaired?
Born in colder months (late winter/early
spring)
Schizophrenia and Brain
Abnormalities
O Difficult to ascertain
O Not necessarily obvious damage but
abnormalities on a cellular level
O Prefrontal cortex, hippocampus
O Enlarged brain ventricles
(USMLE
Pathology Slides)
O Fei Du, PhD, and colleagues found
evidence of abnormalities in both
myelin and axons (Biological Psychiatry, 2013)
Schizophrenia &
Neurotransmitters
O Dopamine
O Schizophrenics tend to have increased
sensitivity/too much released
O Hypothesized due to amphetamine effects
O Glutamate
O Schizophrenia may inhibit glutamate
O Hypothesized due to PCP effects
O Serotonin
O Elevated levels may be associated with
schizophrenia
O Hypothesized due to hallucinogen effects
Schizophrenia Treatment
O Medications
O Side effects
O Uncontrollable movements (shaking, fidgeting,
involuntary facial contortions)
O Weight gain
O High blood sugar, cholesterol
O Loss of sex drive
O Psychosocial therapy
O Hospitalization
O WA: Involuntary Treatment Act (72 hrs);
petitions required for longer periods
Schizophrenia Treatment
O Although many diagnosed with
schizophrenia are disabled, others are
able to work and function
O Tony Allard: His brother conducts an
interview (YouTube; at least through
5:00)
O Dennis Allard’s blog
O Living with Schizophrenia: A Call for
Hope and Recovery
Schizophrenia Resources
O Crisis Clinic: 206-
461-3222 (1-8664CRISIS toll free)
O Community House
Mental Health (206362-0560)
O Snohomish County:
(425) 388-7215
Mood Disorders
Mood Disorders
O An exaggeration of mood (affect)
O Depression
O Mania
O Anger
O Irritability
O Examples
O Major depressive episode
O Manic episode
O Bipolar I, Bipolar II
Mood Disorders - Change in
DSM-V
O Proposed separate categories
O Depressive Disorders
O Bipolar and Related Disorders
Major Depressive Episode
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Extreme sadness
Loss of interest in daily activities
Weight loss or gain
Sleep disturbances
Fatigue/loss of energy nearly every day
Diminished ability to concentrate
Recurrent thoughts of death
Not due to a chemical substance
Extreme impairment in daily functioning
Depressive Disorders
O Dysthmic Disorder
O Major Depressive Disorder
O Single Episode
O Recurrent
O Two or more major depressive episodes
O At least two months criteria for major
depressive episode are unmet
Manic Episode
O Distinct period of elevated mood, at
least one week
O Symptoms
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Inflated self-esteem
Reduced sleep
Talkativeness
Racing thoughts, distractibility
O Causes severe impairment
O Not due to chemical substance
Bipolar Disorders
O “Manic depressive”
O Dramatic mood swings involving
depression, mania and/or hypomania
O Hypomania generally less severe than
mania
O Video Clips (BBC)
Bipolar I Disorder
O At least one manic or mixed episode
O Mixed: major depressive and manic
episodes are evident
O There may also be major depressive
episodes and/or hypomania
Bipolar II Disorder
O History of one or more major depressive
episodes
O History of one or more hypomanic
episodes
O No manic or mixed episodes
O Symptoms cause significant stress
Other Bipolar Diagnoses
O Cyclothymic
Disorder/
Cyclothymia
O Rapid Cycling
Bipolar Disorder
O Bipolar Disorder Not
Otherwise Specified
Other Bipolar Diagnoses