Mental Illness and
Treatment
Blind Pig Syndrome
The belief that one has all
illnesses which one hears
about.
Insanity Defense
M’Naughten Rule: Insanity is a
legal term that one is not aware
or responsible for their own
actions.
1954 Durham Rule, says one is
not responsible for their actions.
Defining Abnormal Behavior
Any behavior state of emotional distress
that causes personal suffering that is selfdestructive or maladaptive.
Statistical Deviation: If normal is what
most people do, Abnormal behavior
deviates from the norm.
Defining Abnormal Behavior
Violation of Cultural Standards:
Any action that violates the standards of the
group. Having visions: religious blessing in
some cultures: Schizophrenic in others.
Maladaptive behavior:
everyday life significantly.
Interrupts
Defining Abnormal Behavior
Emotional Distress:
Feels, angry,
anxious afraid or depressed most of the time.
Impaired Judgment: Cannot tell right
from wrong or control their own behavior.
Deviant, Distressful &
Dysfunctional
Carol Beckwith
1. Deviant behavior (going
naked) in one culture
may be considered
normal, while in others
it may lead to arrest.
2. Deviant behavior must
accompany distress.
3. If a behavior is
dysfunctional it is
In the Wodaabe tribe men
wear costumes to attract
women. In Western society
this would be considered
abnormal.
Understanding Psychological Disorders
Ancient Treatments of psychological disorders
include trephination, exorcism, being caged like
animals, being beaten, burned, castrated,
mutilated, or transfused with animal’s blood.
Trephination (boring holes in the skull to remove evil forces)
Medical Model
When physicians discovered that syphilis led to
mental disorders, they started using medical models
to review the physical causes of these disorders.
1.
2.
3.
4.
Etiology: Cause and development of the disorder.
Diagnosis: Identifying (symptoms) and distinguishing one disease from another.
Treatment: Treating a disorder in a psychiatric hospital.
Prognosis: Forecast about the disorder.
Medical Perspective
Dance in the madhouse.
George Wesley Bellows, Dancer in a Madhouse, 1907. © 1997 The Art Institute of Chicago
Philippe Pinel (1745-1826) from France, insisted
that madness was not due to demonic
possession, but an ailment of the mind.
Biopsychosocial Perspective
Assumes that biological, socio-cultural, and
psychological factors combine and interact to
produce psychological disorders.
Psychological Disorders
Thomas Szasz
believes that mental illnesses are socially,
not medically, defined.
DSM-5
Make a case for Anxiety or
obsessive compulsive classification
Anorexia
bulimia
hypochondria
DSM 5 and ICD
Guide to understanding the difference
Another helpful link
Schizophrenia Spectrum Disorder
and Other Psychotic Disorders
In the DSM-IV there were subtypes: paranoid,
disorganized, catatonic, undifferentiated, and
residual.
In the DSM-5 there are not subtypes as they
are not stable conditions, and have poor validity
and reliability, Catatonic also a separate
category.
Schizophrenia Spectrum Disorder
delusions
hallucinations
disorganized speech
disorganized thought
catatonic behavior
negative symptoms
In the DSM-5 two of symptoms are required AND at least one symptom must be one of the first three (delusions,
hallucinations, disorganized speech).
(AMHC 2015)
Theories of Schizophrenia
Biological: Chromosomes 6 & 22 related to
schizophrenia, but so many symptoms, no single
physical deficiency. Abnormal levels of Dopamine.
May be overly sensitive to everyday stimuli.
Genetic Factors: 1 in 100 in normal pop,1 in
10 if sibling, 1 in 2 if identical twin.
Brain Disorder: Lack of oxygen to the brain,
toxic chemicals; infection (syphilis). Time of year
Biological Factors
Abnormal Brain Morphology
Both Photos: Courtesy of Daniel R. Weinberger, M.D., NIH-NIMH/ NSC
Schizophrenia patients may exhibit
morphological changes in the brain like
enlargement of fluid-filled ventricles.
Abnormal Brain Activity
Paul Thompson and Arthur W. Toga, UCLA Laboratory of Neuro
Imaging and Judith L. Rapport, National Institute of Mental Healt
Brain scans show abnormal activity in the
frontal cortex, thalamus, and amygdala of
schizophrenic patients. Adolescent
schizophrenic patients also have brain lesions.
Environmental Factors
Viral Infection
Schizophrenia has also been observed in
individuals who contracted a viral infection (flu)
during the middle of their fetal development.
Family Influences on Schizophreni
Family variables
parental communication that is
disorganized, hard-to-follow, or highly
emotional
expressed emotion
• highly critical, over-enmeshed families
Cultural Differences in Schizophreni
Prevalence of symptoms is similar no matter
what the culture
Less industrialized countries have better rates
of recovery than industrialized countries
families tend to be less critical of the patients
less use of antipsychotic medications, which may impair
full recovery
think of it as transient, rather than chronic and lasting
disorder
Summary of Schizophrenia
Many biological factors seem involved
heredity
neurotransmitters
brain structure abnormalities
Family and cultural factors also important
Combined model of schizophrenia
biological predisposition combined with psychosocial
stressors leads to disorder
Is schizophrenia the maladaptive coping behavior of a
Theories on Schizophrenia
Anti-Psychotic Drugs: Major
tranquilizers (Theorizine, Halodel). Previously
used padded cells and straight jackets.
Reduce pain and agitation. Shorten episodes.
Block receptor sites for dopamine.
Anti-Psychotic Drugs
Clorazil: Sometimes awakens catatonic
patients.
Clozapine: Dampens responsiveness to
irrelevant stimuli.
Thorazine: Omits delusions and
hallucinations.
Schizoaffective Disorder
Schizoaffective disorder forms a link between psychosis and mood. Previously, DSM-IV required that the mood episode be
present for a substantial duration of the illness. DSM-5 requires the mood episode be present for the majority of the illness. It
probably seems like splitting hairs but the change was made to improve the reliability, validity, and stability of the disorder. After
all, how long is “substantial” anyway?”
(AMHC, 2015)
Delusion Disorder
Not all delusions will be considered signs of a
psychotic disorder
Catatonic Disorder
Immobility, stupor in motor ability. May hold
a position for hours, shows definite signs of
psychosis.
Anxiety Disorders
separation anxiety disorder
selective mutism
specific phobia
social phobia, panic disorder
agoraphobia
generalized anxiety disorder
Model of Development of GAD
GAD has some genetic component
Related genetically to major depression
Childhood trauma also related to GAD
Genetic predisposition
or childhood trauma
Hypervigilance
GAD following life
change or major event
Phobias
An unrealistic fear of a specific situation:
Activity or thing. Simple phobias (I.e.
Claustrophobia).
Agoraphobia: half of all phobia cases: Fear
of being alone in public places from which
escape or help might be difficult. Usually
home is a safe place.
Heritable component
Panic Attacks
A brief feeling of intense fear and
impending doom or death
accompanied by intense
physiological symptoms such as
rapid breathing, dizziness and
sweaty palms.
Behavioral Therapies
Work on changing current behaviors and
attitudes. Assumes that behavior IS the
problem.
Systematic Desensitization: (Wolpe) Stepby-Step process of getting a subject acclimated
to a feared object. Relaxing in a hierarchy that
gradually leads to greater fear. Must be
relaxed before moving on.
Behavioral Therapies
Flooding: (Implosive Therapy) Take patient
directly into their most feared situation. Can be
physically harmful.
Counter conditioning: (Mary Cover
Jones) Conditions new responses to stimuli
that trigger unwanted behavior. Based on
classical conditioning.
Behavioral Therapies
Aversive Conditioning: Punishment to
replace positive reinforcement that perpetuates
a bad habit.
Behavioral Records: and contracts:
Ways of changing unwanted habits, keep a
running record of when a given habit or
behavior occurs.
Behavioral Therapies
Token Economy: Rewards desired behaviors,
patient exchanges tokens for various privileges
or treats. Usually used in mental health care
facilities.
Criticisms: When reinforcement stops, so
does wanted behavior. Extrinsically rewarding:
person in control of someone else’s behavior.
The Learning Perspective
Investigators believe that fear responses are
inculcated through observational learning.
Young monkeys develop fear when they watch
other monkeys who are afraid of snakes.
Parents transmit their fears to their children.
The Biological Perspective
Natural Selection has led our ancestors to learn
to fear snakes, spiders, and other animals.
Therefore, fear preserves the species.
Twin studies suggest that our genes may be
partly responsible for developing fears and
anxiety. Twins are more likely to share
phobias.
The Biological Perspective
General anxiety, panic
attacks, and even
obsessions and
compulsions are
biologically measurable
as an overarousal of
brain areas involved in
impulse control and
Anterior Cingulate Cortex
of an OCD patient.
Obsessive Compulsive Spectrum
Disorders/and related disorders
obsessive-compulsive disorder
body dysmorphic disorder
hoarding disorder
trichotillomania
excoriation disorder
Obsessive Compulsive Spectrum
Disorders/and related disorders
“OCRDs are characterized by repetitive thoughts, distressing emotions, and compulsive behaviors. The specific types of thoughts,
emotions, and behaviors vary according to each disorder within this group. Although there is symptom similarity and overlap, each
disorder has its own unique features. These differences affect treatment decisions in several important ways: 1) the type of
treatment selected; 2) the order, and pace of therapeutic interventions; and, 3) the goals and expectations of clinicians, therapy
participants, and family members (AMHC, 2015)”
Characteristics
Obsessions and Compulsions
Characteristics
Irrational Vs. Distorted Beliefs
Trauma and Stress Disorders
Trauma and Stressor-Related Disorders
Reactive attachment disorder
disinhibited social engagement disorder
PTSD
acute stress disorder
adjustment disorder
Somatic Symptoms Related
Disorders
no longer referred to as somatoform disorders
Hypochondriasis
Bipolar and Related Disorders
“
In DSM-IV, Criterion A for Manic Episode included elevated, expansive and irritable mood. In addition to elevated mood, DSM-5
added changes in energy and activity levels. This broadened inclusion was made because changes in energy and activity are
more readily observed and reported in early stages of the disorder. The goal was to improve diagnostic accuracy and to facilitate
early detection and treatment. Opponents object to this broadened inclusion, fearing more people may be prematurely diagnosed
and improperly medicated.”
Manic and depressive episodes
(AMHC, 2015)
Bipolar Disorder (Manic-Depressive)
Alternate between depression
and mania.
Mania
High state of exhilaration (flight of ideas)
feelings of power, plans, ambition, widely
optimistic. Inflated sense of self-esteem.
Speaks dramatically, many jokes or puns.
Depression
Major depression
Persistent Depression Disorder (DSM-5) vs.
Dysthymia (DSM-IV)
Depression Related Disorders
Grief/Bereavement exclusion for depression has been removed
Bereavement
How long does it last?
Genetic Influence?
Major Depressive Episodes?
Treatment and response?
BUT…
Is grief really “depression” or is it just part of existence?...where is that
fine line again???
Depression Related Disorders
Disruptive Mood Dysregulation and Premenstrual
Dysphoric Disorder.
Neurotransmitters &
Depression
A reduction of
norepinephrine and
serotonin has been
found in depression.
Drugs that alleviate
mania reduce
Pre-synaptic
Neuron
Serotonin
Norepinephrine
Post-synaptic
Neuron
Biological Perspective
Genetic Influences: Mood disorders run in
families. The rate of depression is higher in
identical (50%) than fraternal twins (20%).
Linkage analysis and association studies link
possible genes and dispositions for depression.
Jerry Irwin Photography
The Depressed Brain
PET scans show that brain energy consumption
rises and falls with manic and depressive
episodes.
Courtesy of Lewis Baxter an Michael E.
Phelps, UCLA School of Medicine
Social-Cognitive Perspective
The social-cognitive perspective suggests that
depression arises partly from self-defeating
beliefs and negative explanatory styles.
Cognitive Bases for Depression
A.T. Beck: depressed people hold pessimistic
views of
themselves
the world
the future
Depressed people distort their experiences in
negative ways
exaggerate bad experiences
Cognitive Bases for Depression
Hopelessness theory
depression results from a pattern of thinking
person loses hope that life will get better
negative experiences are due to stable, global reasons
e.g., “I didn’t get the job because I’m stupid
and inept” vs. “I didn’t get the job because the interview
didn’t go well”
Depression Cycle
1.
2.
3.
4.
Negative stressful events.
Pessimistic explanatory style.
Hopeless depressed state.
These hamper the way the individual thinks
and acts, fueling personal rejection.
Anti-Depressants
Stimulants that influence neurotransmitters in
the brain. Elevates levels of seretonin. Nonaddictive, side effects dry mouth, constipation.
Anti-Depressants
Prozac: blocks reabsorption and removal of
seretonin from synapses. Cousin of Zoloft and
Paxil, side effects, weight gain, dry mouth and
dizzy spells.
Lithium: Calms people with manic-depressive
disorder. Can be dangerous.
Anti-Depressants
Valium: Tranquilizers, depressants, frequently
prescribed to people complaining of
unhappiness or anxiety. Least effective and
addictive.
Anti-Anxiety Drugs: reduce tension and
anxiety without causing excessive sleepiness.
Reduce symptoms without resolving underlying
problem.
Disruptive, Impulse Control, and
Conduct Disorders
Conduct Disorder
Antisocial Personality Disorder
Substance Related and Other
Addictive Disorders
substance abuse and substance dependence
into a single disorder measured on a continuum
from mild to severe.
Internet Gaming Disorder is in section III, thus it
is not an official disorder
Personality Disorders
DSM-5 Personality Disorders
DSM-5 Tidbits
"other specified-" and "unspecified-" diagnosis. vs “not otherwise specified.”
Located in Section III, Emerging Measures and Models, is the alternative
Psychosurgery
Frontal Lobe Lobotomy: Cut fibers in
the frontal lobe. In the 1950s many were
conducted, today is is generally illegal, only
used in the most severe cases.
Cognitive Therapy
Tries to teach people more positive ways of
thinking. Attempts to replace negative thoughts
with rational responses.
Internalized Sentences: Talking to one’s
self, using self-defeating thoughts. Personalize
failure; overgeneralize, jump to conclusions.
Cognitive Therapy
Thought Processes: Need to change
thoughts from being internalized, stable and
global.
Rational-Emotive Therapy: Albert Ellis
(Aaron Beck), vigorously challenges peoples
illogical, self-defeating attitudes and
assumptions to stop catastrophizing and
awufilizing.
Humanistic Therapy
Try to move one toward self-fulfillment and to
take responsibility for their actions.
Client-Centered Therapy: (Rogers),
listening with genuine acceptance to help them
begin to heal themselves (non-directive).
Humanistic Therapy
Existential Therapy: Helps clients find
meaning in existence. Gives them the power to
control their own destinies.
Active Listening: Echoing, Restating, and
seeking clarification of what a person
expresses.
Humanistic Therapy
Unconditional Positive Regard:
Therapists must be warm and show
unshakeable regard for their client. They must
be genuine and honest.
Group Therapy
Helps patients express their problems and
show that they are not alone in suffering from
this illness.
Gestalt Therapy
Commonly used in institutions and prisons.
Focuses on looking at an individual as a whole.
Can teach individuals to be more self-assertive
and to use more self-revelation.
Family Therapy
Usually used to help children and adolescents.
Role-Play, facilitate good communication.
Eclectic Approach
Combine one or more treatments to most
effectively treat the client. More popular type of
treatment.
Effectiveness of Psychotherapy
Good Relationships with therapist seems to be
more effective than type of treatment used.
Alternatives: Encounter Groups, self-help
tapes, books
Psychosurgery
Destroys selective area of the brain. Last
resort.
Electroconvulsive Therapy (ECT):
used with major depression; increase brain
activity; electrodes attatched to head, throws
patient into a short seizure.