Module Notes
Module 66: Anxiety Disorders, OCD, and PTD
- Anxiety Disorders
• Generalised anxiety Disorder: an anxiety disorder in which a person is continually tense,
apprehensive, and in a state of autonomic nervous system arousal.
- marked by pathological worry.
- the symptoms of this disorder are commonplace; their persistence, for six months or more,
is not.
- 2/3 women
- continual worry, jittery, agitated and sleep deprived
- free oating anxiety
- concentration is dif cult as attention switches from worry to worry, and their tensions and
apprehension may leak out through furrowed brows, twitching eyelids, trembling,
perspiration , or dgeting.
• Panic Disorder: an anxiety disorder marker by unpredictable, minutes - long episodes of
intense dread in which a person experiences terror and accompanying chest pain, choking, or
other frightening sensations. Often followed by worry over a possible next attack.
- Panic attacks
• Phobias: an anxiety disorder marked by a persistent, irrational fear and avoidance of a
speci c object, activity, or situation.
- panic attacks
- avoid situations where the panic has struck
- fear is intense
- become agoraphobia
- avoid being outside the home, in a crowd, on a bus, or on an elevator
- Obsessive-Compulsive Disorder: a disorder characterised by unwanted repetitive thoughts
(obsessions) and/or actions (compulsions)
• types of OCD: checkers, cleaners, counters, hoarders
- Post-traumatic Stress Disorder: a disorder characterised by haunting memories, nightmares,
social withdrawal, jumpy anxiety, numbness of feeling, and/or insomnia that lingers for four
weeks or more after a traumatic experience.
- Post-traumatic growth: positive changes as a result of struggling with extremely challenging
circumstances and life crises.
- Understanding the disorders
- The learning perspective
1. classical and operant conditioning
- stimulus generalization
- reinforcement
2. observational learning
3. cognition
- The biological perspective
1. natural selection
2. genes
- anxiety gene
- glutamate
3. the brain
- anterior cingulate cortex
- amyglada
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Module 67: Depressive & Bipolar Disorders
- Depressive Disorders
- Mood disorders: psychological disorders characterised by emotional extremes
- 2 forms:
a. major depressive disorder —prolonged hopelessness and lethargy
• a mood disorder in which a person experiences, in the absence of drugs or another
medical condition, two or more weeks with ve or more symptoms, at least one of
which must be either (1) depressed mood or (2) loss of interest or pleasure
• Persistent depressive disorder (dysthymia): a mildly depressed mood more often
than not for at least two years
• problems regulating appetite
• problems regulating sleep
• low energy
• low self-esteem
• dif culty concentrating and making decisions
• feelings of hopelessness
b. bipolar disorder — a mood disorder in which a person alternates between the
hopelessness and lethargy of depression and the overexcited state of mania
• Mania (manic): a mood disorder marked by a hyperactive, wildly optimistic state.
• Disruptive Mood Dysregulation Disorder (for children and adolescents)
- Understanding Depressive and Bipolar disorders
- many behavioural and cognitive changes accompany depression
- people are inactive and feel unmotivated
- they are sensitive to negative happenings
- they more often recall negative information
- they expect negative outcomes
- The biological perspectives
- genetic in uences
- mood disorders run in families
- heritability
- linkage analysis: geneticists examine DNA from affected family members, looking for
differences.
- biochemical in uences
- norepinephrine and serotonin
• Drugs that relieve depression tend to increase norepinephrine or serotonin supplies by
blocking either their reuptake (as Prozac, Zoloft, and Paxil do with serotonin) or their
chemical breakdown.
• Repetitive physical exercise, such as jogging, reduces depression as it
increases serotonin.
• Boosting serotonin may promote recovery from depression by stimulating hippocampus
neuron growth.
• People who eat a heart-healthy “Mediterranean diet” (heavy on vegetables, sh, and olive
oil) have a comparatively low risk of developing depression.
• Excessive alcohol use also correlates with depression—mostly because alcohol misuse
leads to depression.
- The social-cognitive perspective
- explanatory style: who or what they blame for their failures (or credit for their successes)
- Depression’s vicious cycle
1. stressful experiences
2. negative explanatory style
3. depressed mood
4. cognitive and behavioural changes
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Module 68: Schizophrenia Spectrum
- Schizophrenia (split mind): a psychological disorder characterised by delusions,
hallucinations, disorganised speech, and/or diminished or inappropriate emotional expression
- Psychosis (psychotic disorder): a psychological disorder in which a person loses contact with
reality, experiencing irrational ideas and distorted perceptions
- Symptoms of Schizophrenia
- Disorganised thinking and disturbed perceptions
• delusions - false beliefs, often of persecution or grandeur, that may accompany psychotic disorders
• word salad
• hallucinations - sensory experiences without sensory stimulation
- Diminished and inappropriate emotions
• inappropriate emotions
• at effect - emotionless state
• inappropriate actions
• catatonia - staying motionless for hours
• disruptive social heavier
- Onset and Development of Schizophrenia
- statistics of schizophrenia
- typically strikes as young people are maturing into adulthood
- knows no national boundaries
- affects both males and females — might struck men earlier, more severely, and more often
- Onset of the disease
- can appear suddenly, seemingly as a reaction to stress
- can develop gradually, emerging from a long history of social inadequacy and poor school
performance
- Positive versus negative symptoms
- PS = presence of inappropriate behaviours: hallucinations, talking in disorganised and deluded
ways, and exhibiting inappropriate laughter, tears, or rage
- NS = absence of appropriate behaviours: having toneless voices, expressionless faces, or mute
and rigid bodies
- Understanding Schizophrenia
- Brain abnormalities: dopamine over-activity
• a six-fold excess for the D4 dopamine receptor = intensify brain signals in schizophrenia, creating
positive symptoms such as hallucinations and paranoia
- treatment: Dopamine blocking drugs
- Abnormal activity in multiple brain areas:
• abnormally low brain activity in the frontal lobes
• out-of-sync neural ring disruption neural networks
• high activity in the thalamus (hallucinations) or amyglada (paranoia)
• enlarged, uid - lled areas
• a shrinkage and thinning of cerebral tissue
- causes: mishaps during prenatal development or delivery, low birth weight, maternal diabetes, older
paternal age, and oxygen deprivation during delivery; and famine
- Genetic factors
- genetic predisposition
- twin studies
- Psychological factors
- warning signs
- mother severely schizophrenic
- birth complications
- separation from parents
- short attention span
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Module 69: Other Disorders
- Somatic Symptom and Related Disorders
- Somatic Symptom disorder: a psychological disorder in which the symptoms take a somatic
(bodily) form without apparent physical cause
- symptoms
• vomiting
• dizziness
• blurred vision
• severe pain
• prolonged pain
- Conversion disorder (functional neurological symptom disorder): a disorder in which a
person experiences very speci c genuine physical symptoms for which no physiological basis
can be found
- symptoms
• loss of sensation in a body part
• unexplained paralysis
• blindness
• inability to swallow
- Illness anxiety disorder (Hypochondriasis): a disorder in which a person interprets normal
physical sensations as symptoms of a disease
• they don't trust anyone’s diagnosis
• they interpret normal sensations as symptoms of a dreaded disease
- Types of Somatoform Disorders
• Conversion Disorder: an expression of psychological con ict or need that involves an
alteration or loss of physical functioning that suggests a bodily cause in the absence of a
medical reason
• Hypochondriasis: preoccupation with having or contracting a series disease in the
absence of a medical reason
• Somatisation Disorders: repeated concern with a variety of bodily complaints in the
absence of a medical reason
• Body Dysmorphic Disorder: preoccupation with an imagined defect in appearance of a
normal-appearing person
• Pain Disorder: Preoccupation with pain in the absence of an adequate physical basis for it.
- Dissociative Disorders
- Dissociative disorders: disorders in which conscious awareness becomes separated
(dissociated) from previous memories, thoughts, and feelings
- Dissociative identity disorder (DID): a rare dissociative disorder in which a person exhibits
two or more distinct and alternating personalities. (formerly called multiple personality
disorder)
- Feeding and Eating Disorders
- Anorexia nervosa: is a characterized by signi cant weight loss
- Bulimia nervosa: an eating disorder in which a person alternates binge eating (usually of
high-calorie foods) with purging (by vomiting or laxative use), excessive exercise, or fasting
- Binge eating disorder: signi cant binge eating episodes, followed by distress, disgust, or
guilt, but without the compensatory purging or fasting that marks nervosa
- Personality Disorders
- Personality disorders: psychological disorders characterized by in exible and enduring
behaviour patterns that impair social functioning
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- Antisocial Personality Disorder
- Antisocial personality disorder: a personality disorder in which a person (usually a man)
exhibits a lack of conscience for wrongdoing, even toward friends and family members. May
be aggressive and ruthless or a clever con artist
• Super cial charm and high intelligence
• Poise, rationality, absence of neurotic anxiety
• Lack of a sense of personal responsibility
• Untruthfulness, insincerity, callousness, manipulativeness
• Antisocial behavior without regret or shame
• Poor judgment and failure to learn from experience
• Inability to establish lasting, close
relationships with others
• Lack of insight into personal motivations
- Understanding antisocial persoanlity disorder
- Biological factors
• No single gene codes for a complex behavior such as crime, but twin and adoption studies
reveal that biological relatives of those with antisocial and unemotional tendencies are at
increased risk for antisocial behavior.
• Molecular geneticists have identified some specific genes that are more common in those
with antisocial personality disorder.
• Levels of stress hormones are lower than average.
• Genetic influences, often in combination with child abuse, help wire the brain. PET scans of
41 murderers’ brains show reduced activity in the murderers’ frontal
lobes, an area of the cortex that helps control impulses.
• Violent repeat offenders had 11 percent less frontal lobe tissue than normal.
- Social Factors
• poverty and family instability
• childhood maltreatment
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Treatment Psychological Disorders
- Early Attempts at Biological Intervention
- Coma and convulsive therapies
- Insulin coma therapy
- Electroconvulsive shock therapy (ECT)
- bilateral ECT and Unilateral ECT
- memory impairment for months
- Neurosurgery
- Psychosurgery or Neurosurgery
- The prefrontal lobotomy
- Very, Very seldom today due to medications
- Psychopharmacological Methods of Treatment
- Psychopharmacology: the science of determining which drugs alleviate which mental
disorders and why they do so.
- Antipsychotic Medications (Neuroleptics / Major Tranquilizers)
1. traditional antipsychotics include side effects including: Tardive Dyskinesia - a
dis guring disturbance of motor control, particularly of the facial muscles
- Atypical Antipsychotics: Zyprexa, Geodon, Risperdal, Clozaril, Seraqil
- side effects
- dry mouth, motor disturbances, sedation, weight gain, damage to liver, risperdal
(lactation in females)
- Antidepressant Medications
- Should be taken for minimum of 9-12 months
1. Monoamine Oxidase (MAO) inhibitors
• inhibits breakdown of neurotransmitters
• used in depression with hypersomnia
• requires dietary supplement
2. Tricyclic Antidepressants (TCAs)
• inhibits reuptake of serotonin & norepinephrine
• cause death with overdose
3. Selective Serotonin Re-uptake Inhibitors (SSRI)
• Prozac, Zoloft, Paxil, Luvox, Lexapro, Celexa
• not as selective as once thought
- Anti anxiety Medications (Anxiolytics / Minor Tranquillizers)
1. Benzodiazepines
• sedative effect
• dependency issues
• used to treat alcohol withdrawal
• high relapse rate after termination of medication
• probably stimulate GABA an inhibitory neurotransmitter
- side effects: Drowsiness and lethargy
2. Lithium for the bipolar mood disorders
• long term use side effects include: thyroid dysfunction, kidney damage, memory and
motor speed problems
- Psychologically Based Therapies
1. Psychotherapy
- the treatment of mental disorders by psychological needs
- to achieve changes a therapist may:
• change maladaptive behaviour patterns
• minimize or eliminate in uences from the environmental condition
• improve interpersonal con icts among motives
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• modify dysfunctional beliefs
• reduce or remove distressing or disabling emotional reactions
• foster a clear cut sense of identity
- Stages of change
• Prochaska’s Levels of Change
1. Pre-contemplation
2. Contemplation
3. Preparation
4. Action
5. Maintenance
6. Termination
2. Psychodynamic Therapies: Freudian Psychoanalysis
- Interpersonal therapy
- object relations
- self psychology
- tend to be time consuming and expensive
- Ef cacy vs Effectiveness
- 4 basic techniques
a. free association
b. analysis of dreams
• manifest content
• latent content
c. analysis of resistance
• an unwillingness or inability to talk about certain thoughts, motives or experiences
d. analysis of transference
• transference — the process whereby clients project onto the therapist attitudes
and feelings they had in a past relationship with a parent or other person close to
them
• countertransference — the process in which the therapist reacts in accord with the
client’s transferred attributions rather than objectively
3. Behaviour Therapy
- Guided exposure
• Systematic desensitization
• In Vivo Exposure
- Aversion therapy
• using of punishment (antabuse)
• driving movie
• pronography and children walking in
- Modelling, Imitation, and Role Playing
- Systematic Use of Reinforcement (Contingency Management)
• response shaping: a behaviour therapy technique using protective reinforcement to
establish by gradual approximation a response that is actively resisted or is not initially
in a person’s behavioural repertoire
• remove reinforcements or add reinforcements
- Cognitive & Cognitive-Behavioural Tx
- Rational emotive behaviour therapy (REBT)
• focus on changing core irruption beliefs
- Stress-Inoculation therapy (SIT)
• three stages include: cognitive preparation, skill acquisition, rehearsal, and
application and process
- Beck’s cognitive therapies
• focus on illogical thinking about self, world, and future
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4. Humanistic-Experiential Therapies
- Client-Cantered (person-centered) therapy
• non directive
• unconditional positive regard
• self-actualization
- Existential Therapy
• the human predicament
• focus on here and now
• therapist is to be authentic
- Gestalt Therapy
• integration of thought, feeling, and action into one’s self-awareness
5. Therapy for Interpersonal Relationships
- Couples Counselling (Marital Therapy)
- Family Systems Therapy
• systemic recursiveness
• identi ed patient
• homeostasis
- Structural Family Therapy (Salvador Minchin)
• family rules and boundaries
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