Abnormal Psychology & Therapy Project

Abnormal Psychology & Therapy Project Mackenzie Brown, Felicia Fantin, Rachel Ninke, & Megan Schmalenberger

Introduction - Abnormal Behavior Abnormal Behavior- Behavior that is deviant, maladaptive or personally distressful over a relatively long period of time. • Deviant → straying from the norm (taking 7 showers a day) • Maladaptive → interferes w/ ability to function (thinks they can hurt others by breathing so they avoid people altogether) • Personal Distress → person engaging in the behavior finds it troubling (a woman who makes herself vomit after a meal) Types of Disorders: Anxiety Disorders, Mood Disorders, Dissociative Disorders, Schizophrenia, Personality Disorders, and Psychological Disorders and Health and Wellness

Introduction - Abnormal Behavior Theoretical Approaches to Psychological Disorders: • Biological Approach - attributes psychological disorders to organic, internal causes and primarily focuses on the brain, genetic factors, and neurotransmitter functioning. • Sociocultural Approach - emphasizes the social contexts in which a person lives, including the individual’s gender, ethnicity, socioeconomic status, family relationships, and culture. • Biopsychosocial approach/model - Abnormal behavior can be influenced by biological factors, psychological factors, and sociocultural factors.

Introduction - Abnormal Behavior Classifying abnormal behavior: provides a common basis for communicating and can help clinicians make predictions about how likely it is that a particular disorder progresses, and what the prognosis is for treatment. DSM-IV → The Diagnostic and Statistical Manual of Mental Disorders; is the major classification of psychological disorders in the United States • Critiques of DSM: - classifies based on symptoms and ignores things like environmental factors - focuses strictly on pathology and problems and doesnt look at strengths

Introduction - Therapy Biological Therapies - Treatments that reduce or eliminate the symptoms of psychological disorders by altering aspects of body functioning. Types of Drug Therapy: • Antianxiety Drugs - Drugs that reduce anxiety by making the individual calmer and less excitable (tranquilizers) • Antidepressant Drugs - Drugs that help regulate a person's mood • Antipsychotic Drugs - Powerful drugs that diminish agitated behavior, reduce tension, decrease hallucinations, improve social behavior, and produce better sleep patterns in individuals with a severe psychological disorder

Introduction - Therapy Other types of Therapy: • Electroconvulsive Therapy - A treatment commonly used for depression that sets off a seizure in the brain • Psychosurgery - Involves the removal or destruction of brain tissue to improve the individual's adjustment Increase Suicide Risk in Children: • Some antidepressants have been know to be associated with suicidal thoughts and actions in children and adolescents but today it is extremely uncommon • As many as 17% of adolescents think about suicide in any given year but most teen suicides do not involve antidepressants

Mood Disorders • Mood disorders are defined as psychological disorders in which there is a primary disturbance of mood: prolonged emotion that colors the individual’s entire emotional state. • The main types of mood disorders are: • Depressive Disorders • Bipolar Disorder

Depressive Disorders • Depressive disorders are mood disorders in which the individual suffers from depression. • Depression: an unrelenting lack of pleasure in life. • The severity of these disorders varies. • There are two main classifications: • Major Depressive Disorder • Dysthymic Disorder

Major Depressive Disorder (MDD) • MDD is a psychological disorder involving a significant depressive episode and depressed characteristics, such as lethargy and hopelessness, for at least two weeks. • Major depression affects about 6.7% of the U.S. population over age 18, according to the National Institute of Mental Health. • Overall, between 20% and 25% of adults may suffer an episode of major depression at some point during their lifetime.

Major Depressive Disorder (MDD) Symptoms: Five of the following must be present during a 2 week period • Depressed mood most of the day • Reduced interest or pleasure in all or most activities • Significant weight loss or gain, or significant decrease or increase in appetite • Trouble sleeping or sleeping too much • Psychological and physical agitation, or, in contrast, lethargy • Fatigue or loss of energy • Feeling worthless or guilty in an excessive or inappropriate manner • Problems in thinking, concentrating, or making decisions • Recurrent thoughts of death and suicide • No history of manic episodes (periods of euphoric mood)

MDD Case Study Pierre, Corporate Lawyer Pierre is an extremely successful corporate lawyer who is well respected by his peers. Although he has always been thought of as gregarious, outgoing and fun-loving, for the past couple of months Pierre has not been feeling quite himself. He no longer enjoys things they way he used to and he feels a profound sense of sadness just about every day; so much so that he feels utterly hopeless about his future. To make matters worse, Pierre’s previously healthy appetite has evaporated and he often finds himself waking up very early in the morning and unable to fall back asleep. Although Pierre has always enjoyed hockey and weight-training, lately he has found that he just doesn’t have the energy to do much of anything. At work, he has been scraping by and cannot seem to concentrate or make quick decisions, both of which have conspired to send his self-esteem and sense of worth into a tailspin. His friends, co-workers and family are growing increasingly concerned as he is returning phone-calls and e-mails less frequently, and seems very withdrawn and despondent.

MDD Case Study Explained... Pierre who we met in our first case study, major depression is characterized by a depressed mood almost everyday for a long-period of time (longer than two-weeks) that causes a lot of distress or negatively impacts functioning at home or at work, as well as a significant reduction in interest or pleasure in previously enjoyable activities. Like Pierre, individuals with major depression often report additional symptoms including dramatic changes in appetite, difficulties with sleep, fatigue or diminished energy, thoughts of worthlessness or extreme guilt, an inability to concentrate. Of course, a major source of concern surrounding depression is the possibility of the depressed individual committing suicide. It is important to note that some medical conditions, prescription medications or withdrawal from drug or alcohol use can cause symptoms that mimic major depression, so it’s essential that these causes first be ruled out.

Dysthymic Disorder (DD) • Mood disorder that is generally more chronic and has fewer symptoms than MDD. • The individual is in a depressed mood for most days for at least two years as an adult or at least one year as a child or adolescent.

Dysthymic Disorder (DD) Symptoms: Two or more of these symptoms must be experienced: • Poor appetite or overeating • Sleep problems • Low energy or fatigue • Low self-esteem • Poor concentration or difficulty making decisions • Feelings of hopelessness

PET scans show higher FDDNP binding (yellow areas) and thus more abnormal proteins in a patient with major depressive disorder compared with a healthy control. FDDNP is a chemical marker created to pinpoint where in the brain abnormal protein deposits are accumulating.

DD Case Study Rahim, Public Sector Lawyer Rahim has been a moderately successful public sector lawyer for the last 20 years. In that time (in fact, ever since he was a young child) Rahim does not remember a period where he has been truly happy—he has always felt a sense of sadness about himself even though he has a loving family. Although intelligent, he suffers from low self-esteem and has always been plagued by poor sleep and low levels of energy. Rahim is functional at work, however, he definitely feels that he has not excelled in his career the way he could have, which he attributes largely to a crippling talent for procrastination about making important decisions, as well as his difficulty concentrating. Although Rahim feels that he certainly isn’t a miserable as he could be, he feels burdened by a nagging sense of hopeless about his situation and worries that he might get even worse one day.

DD Case Study Explained... In our third case study, we met Rahim who is affected by a mood-disorder called dysthymia. Dysthymia has many of the symptoms of major depression, but typically they are milder (but can be equally as debilitating in some cases). A characteristic feature of dysthymia is that the person is affected by low-level symptoms of depression for a very long time (e.g., at least 2 years). In fact, some dysthymic individuals report having never felt happy their entire lives. Individuals who are dysthymic can also be affected from what is called “double-depression”. Essentially, the individual starts out being dysthymic, but then slips into a deeper, major depression, which can sometimes be difficult to treat.

Biological Factors • Genetics play a role in depression. • Specific brain structures and neurotransmitters are involved. • Ex: Depressed individuals show lower levels of brain activity in the part of the prefrontal cortex involved in initiating behavior. • Also, the ventromedial prefrontal cortex which is associated with the perception of rewards in the environment may differ in depressed and non-depressed individuals. This suggests that a depressed person’s brain may not recognize opportunities for pleasurable experiences. • Depression likely involves problems with the body’s regulation of a number of neurotransmitters. • Individuals with MDD seem to have difficulty regulating the neurotransmitter serotonin or have too few receptors for serotonin and norepinephrine.

Sociocultural Factors • Individuals with a low socioeconomic status especially people living in poverty are more likely to develop depression than their higher status counterparts. • A longitudinal study of adults revealed depression increased as standard of living and employment circumstances worsened. • In gender terms, women are nearly twice as likely as men to be diagnosed with depression, minority women are also at a high risk for depression.

Psychological Factors • One of behavioral view of depression focuses on learned helplessness & individuals acquisition of feelings of powerlessness when exposed to aversive circumstances such as prolonged stress. • Cognitive explanations of depression have focused on the kinds of thoughts and beliefs that can attribute to the sense of hopelessness. • Ex: a person who is depressed might overgeneralize about a minor occurrence say turning in a work assignment late and think that he/she is worthless. • The course of depression can be influenced by not only what people think but how they think depressed individuals may focus on negative experiences and feelings playing them over & over again in their head. • Another cognitive view of depression focuses on the attributions people make-their attempts to explain what caused something to happen. • Depression thought to be related to a pessimistic attributional style. In this style individuals regularly explain negative events as having internal causes.

Depression in Children Mood disorders are among the most common mental health problems experienced by children and adolescents. They include all types of depression as well as Bipolar Disorders (formerly called Manic-Depression) and are sometimes referred to as “affective disorders.” Children with mood disorders often are either depressed, manic (unrealistically “up” or hyper), or alternating between the two. Mood disorders are generally caused by chemical imbalances in the brain but also can be triggered by environmental causes, as with Seasonal Affective Disorder; a prolonged or severe medical illness; or biological influences, such as Postpartum Depression. Often mood disorders go undiagnosed because the symptoms can mimic the normal emotional swings and behavior issues associated with growing up, or resemble the symptoms of another disorder. This is particularly true in adolescence when hormonal changes, peer pressures, and rapid physical and cognitive development occur. Additionally, many youth are reluctant to seek help when they are struggling emotionally because of the lingering — and very counterproductive — stigma associated with mental health problems. Left untreated, though, mood disorders can lead to serious academic and behavior problems, possible school failure, extreme irritability, substance abuse, very risky or self-injurious behaviors, or even suicide.

Treatment for Children • Mood disorders usually can be treated effectively. Specific treatments should be recommended as a result of a thorough evaluation conducted by a specialist in child mental health and based on: • Age, overall health, and medical history of the child or adolescent. • Extent and severity of the condition. • Type of mood disorder. • Child and parents’ tolerance for specific medications, procedures, and/or therapies. • Prognosis or expectations for the course of the condition. • Opinions and preferences of the parents and the child (if appropriate) in collaboration with mental health professionals.

Treatment For Children Treatment may include one or more of the following: • Medications such as antidepressants and mood stabilizers, especially when combined with psychotherapy, have been shown to be very effective in the treatment of depression. • Psychotherapy, such as cognitive-behavioral and/or interpersonal therapy focused on helping the person change distorted views of themselves and the environment around them; helping them to improve their interpersonal relationship skills; and identifying stressors in the environment, how to avoid them, and how to cope effectively with those which cannot be avoided. • Family therapy — families play a vital, supportive role in any treatment process. http://www.nasponline.org/publications/cq/cq353mooddisorders.aspx

Treatment In General Treatment for mood disorders may include: • Psychotherapy • Self Help • Medication • A class of antidepressants called selective serotonin re-uptake inhibitors (SSRIs) are the most commonly prescribed medication for chronic depression today. Prozac (fluoxetine), Paxil (paroxetine), Zoloft (sertraline) and Luvox (fluvoxamine) are the most commonly prescribed brand names. OTHER TREATMENTS FOR DEPRESSION • Electroconvulsive therapy (ECT) may improve mood in people with severe depression or suicidal thoughts who do not get better with other treatments. ECT is generally safe. • Light therapy may relieve depression symptoms in the winter time. This type of depression is called seasonal affective disorder.

Bipolar Disorder • Bipolar Disorder is also known as manic-depressive disorder. • Brain disorder that causes unusual shifts in mood, energy, activity levels, and the ability to carry out daily tasks. • It is characterized by extreme mood swings that include one or more episodes of mania, an overexcited, unrealistically optimistic state.

BiPolar Disorder • The severity of the manic episodes is used to distinguish between the two types: • BiPolar Disorder I: refers to individuals who have extreme manic episodes during which they may experience hallucinations (seeing &/or hearing things that are not really there). • BiPolar Disorder II: A milder version. The individual may not experience full-blown mania but rather a less extreme level of euphoria.

Bipolar Case Study Alia, Real-Estate Lawyer Alia is a self-employed real-estate lawyer who thus far has enjoyed an accomplished and rewarding career. Although Alia has always been known for being driven, lately her energy seems boundless. She has taken on an extraordinary number of cases and often works three or four days straight without sleeping or so much as a quick nap, yet she remains completely functional. Recently, friends have remarked that Alia seems to be much more talkative than usual, almost as if she cannot get out the words fast enough. Alia herself has noticed that she seems to have a million thoughts racing through her head at any given time and that she is hopelessly distracted. Although Alia has been generating a lot of revenue through her increased caseload, she’s been prone to wild spending sprees, racking up $17,000 in credit card bills in just the last two weeks. Both Alia’s friends and family have been put off by her growing sense of grandiosity and irritability and are troubled by her frequent proclamations of being “the best lawyer in the entire world”. Alia’s husband is particularly troubled by these changes in Alia as he remembers her being very subdued and sad only a few months ago. At that time she had seemed inconsolable and had only a fraction of the energy she now possesses.

Bipolar Case Study Explained... Bipolar Disorder In our second case study, we were introduced to Alia, who as you might have guessed suffers from a mood disorder called bipolar disorder (which is also sometimes called manic-depression). Bipolar disorder has symptoms of both major depression and what is referred to as “mania”. Just as sometimes feeling a little blue does not mean we are clinically depressed, occasionally feeling elated or energized does not mean we are manic. A bona fide manic episode is characterized by a continuously heightened, exaggerated or irritable mood that is out of the ordinary for that person and that lasts for a lengthy period of time (e.g., a week or two). As in Alia’s case, someone in the midst of a manic episode will often display a host of other symptoms including a greatly inflated sense of self-esteem or grandiose behaviour, reduced need for sleep, excessive talkativeness, racing thoughts, increased purposeful activity and reckless participation in enjoyable activities that can often get the person in trouble (e.g., spending sprees, sexual indiscretions etc.). The hallmark characteristic of bipolar disorder is cycling through periods of mania and then depression. Like major depression, a variety of underlying physical conditions, medications and drugs can cause symptoms similar to bipolar disorder, so these must be considered as well.

Bipolar Treatment • Because bipolar is a life-long recurrent illness, it needs long-term treatment to maintain control over its symptoms. • This may include meditation and psychotherapy • Also, mood stabilizing medications may be prescribed. • Lithium (sometimes known as Eskalith or Lithobid) was the first mood-stabilizing medication approved by the U.S. Food and Drug Administration (FDA) in the 1970s for treatment of mania. It is often very effective in controlling symptoms of mania and preventing the recurrence of manic and depressive episodes. • Valproic acid or divalproex sodium (Depakote), approved by the FDA in 1995 for treating mania, is a popular alternative to lithium for bipolar disorder. It is generally as effective as lithium for treating bipolar disorder.23, 24 Also see the section in this booklet, "Should young women take valproic acid?" • More recently, the anticonvulsant lamotrigine (Lamictal) received FDA approval for maintenance treatment of bipolar disorder. • Other anticonvulsant medications, including gabapentin (Neurontin), topiramate (Topamax), and oxcarbazepine (Trileptal) are sometimes prescribed. No large studies have shown that these medications are more effective than mood stabilizers.

Suicide • Life with the psychological disorder can be so difficult that some individuals choose to end it. • Suicide is not diagnosable but it is a tragic consequence of psychological disorders most commonly depression and anxiety. • Individuals suffering from depression are also likely to attempt suicide more than once. • Thinking about suicide is not necessarily abnormal; however, attempting or completing the act is. • According to the National Institute of Mental Health, in 2004 32,439 people in the United States committed suicide. • Suicide is the third leading cause of death among children in the United States ages 10 to 14.

Biological Factors • Genetic factors appear to play a role in suicide which tends to run in families. • Numbers of studies have linked suicide with low levels of the neurotransmitter serotonin. • Individuals who attempt suicide and who have low serotonin levels are 10 times more likely to attempt suicide again than are attempters who have high levels. • Poor physical health especially when it is long-standing and chronic is another risk factor for suicide.

Psychological Factors • Psychological factors that can attribute to suicide include mental disorders and traumas such a sexual abuse. • Struggling with the stress of psychological disorder can leave a person feeling hopeless and affect the person's ability to cope with life's difficulties. • Approximately 90% of individuals who commit suicide are estimated to have a diagnosable psychological disorder. • An immediate and highly stressful circumstances such as the loss of a loved one or job, flunking out of school, or an unwanted pregnancy can lead people to threaten and or to commit suicide. • Substance-abuse is also linked to suicide

Sociocultural Factors • Chronic economic hardship can be a factor suicide. • Cultural and ethnic context also related to suicide attempts in the United States. • Adolescent suicide attempts vary across groups. • More than 20% of American Indian/Alaska Native female adolescents reported that they had attempted suicide in the previous year. • Suicide accounts for almost 20% of deaths in 15 to 19-year-olds in that category. • African-American the non-Latino white males reported the lowest incidence of suicide attempts. • A major risk factor in the high rate of suicide attempts by American Indian and Alaska Native adolescents is their elevated rate of alcohol abuse

Sociocultural Factors • Suicide rates vary worldwide: • The lowest occur in countries with cultural and religious norms against ending one's own life. • There are gender differences in suicide as well: • Women or three more times likely to attempt suicide than men. • However, men are four times more likely to complete suicide and women. • Men are also more likely than women to use a firearm in a suicide attempt. • The highest suicide rate is among non-Latino white men ages 85 and older. • Although women are more likely than men to be diagnosed with depression, men are more likely to commit suicide. • The explanation for this may be that men are less likely to seek treatment when they are suffering depression.

Dissociative Disorders -Psychological disorders that involve a sudden loss of memory or change in identity due to the dissociation individual’s conscious awareness from previous memories and thought. -Dissociation- Refers to psychology states in which the person feels disconnected from immediate experience. Types of Dissociative Disorders: Dissociative Amnesia Dissociative Fugue Dissociative Identity disorder Video: http://education-portal.com/academy/lesson/dissociative-disorders.html#lesson

Dissociative Amnesia Amnesia- The inability to recall important events -Amnesia can result in the blow to the head that produces trauma in the brain. Dissociative Amnesia- is a type of amnesia that is characterized by extreme memory loss that is caused by extensive psychological stress. -A person experiencing dissociative amnesia still remembers things like how to hail a cab or use a phone. Only aspects of their own identity and autobiographical experiences are forgotten.

Dissociative Amnesia Case: One case involved a 28 year old who had given birth to her sixth child. After she had delivered the child, her family noticed that she did not acknowledge her newborn as her own baby and that she had neither recollection of having given birth nor a sense of her own identity. She had maintained the belief that although she had been pregnant, she had not given birth.

Dissociative Amnesia Treatments: Psychotherapy- type of therapy for mental and emotional disorders Medication- There is no medication to treat dissociative disorders themselves, but people with this disorder also suffer from anxiety and depression and may benefit from the medication.

Dissociative Fugue Dissociative disorder in which the individual not only develops amnesia but also unexpectedly travels away from home and sometimes assumes a new identity. -The difference between dissociative fugue from amnesia is the tendency to run away.

Dissociative Fugue Symptoms: * Sudden and unplanned travel away from home * Inability to recall past events or important from the person’s life *Confusion or loss of memory about his or her identity, possibly assuming a new identity to make up for the loss. * Extreme distress and problems with daily functioning

Dissociative Fugue Case Study: Commonly, individuals who experience the onset of dissociative fugue are found wandering in a dazed or confused state, unable to recall their own identity or recognize their own relatives or daily surroundings. Often, they have suffered from some post-traumatic stress, as in the case of a 35-year-old businessman who disappeared more than 2 years after narrowly escaping from the World Trade Center attack in 2001, leaving behind his wife and children. The man was missing for more than 6 months when an anonymous tip helped police in Virginia identify him.

Dissociative Identity Disorder (DID)- Formerly called multiple personality disorder, a dissociative disorder in which the individual has two or more distinct personalities or identities, each with its own memories, behaviors, and relationships. - Most dramatic, least common and most controversial dissociative disorder - One identity dominates at one time, another takes over at another time

Dissociative Identity Disorder Symptoms: * Feeling like more than one person * Feeling unreal * Hearing voices inside their head that are not their own * Not recognizing themselves in the mirror * Dissociation * Blackouts * Often being accused of lying

Dissociative Identity Disorder Facts: * DID is diagnosed 9 times more often in females than in males * A history of severe abuse is thought to be associated DID * DID had been portrayed in the media in productions like The Three Faces of Eve Treatment: * Hypnosis * Psychotherapy * Medication * Eye movement desensitization and reprocessing (EMDR)

Schizophrenia Define-A severe psychological disorder characterized by highly disordered thought processes, referred to as psychotic because they are so far removed from reality. -Disorder is referred to as “psychotic” because it is far removed from reality -Powerful medications are one of the few ways to control such a disorder http://education-portal.com/academy/lesson/schizophrenia.html#lesson

Symptoms of Schizophrenia Positive Symptoms are marked by a distortion or an excess of normal function. (They reflect something added above and beyond normal behavior). Hallucinations-Sensory experiences in the absence of real stimuli. -usually auditory(hearing voices) -visual( seeing things that are not there) -smells and tastes ex.)seeing bugs crawling over the bed even tho they are not actually there Delusions-False, unusual, and sometimes magical beliefs that are not part of an individual’s culture. -seem completely illogical, but the experience is all too real ex.)someone might think they are Jesus Christ Referential Thinking-Ascribing personal meaning to completely random events. ex.)someone might believe that the traffic light turned red because they are in a hurry Catatonia-State of immobility and unresponsiveness for long periods of time. ex.)run up and down a flight of stairs repeatedly

Symptoms of Schizophrenia Negative Symptoms reflect social withdrawal, behavioral deficits, and the loss or decrease of normal functions. Flat affect-The display of little or no emotion-a common negative symptom of schizophrenia. -Have trouble reading the emotions of others -Lack of positivity -No ability to plan -Goal-directed behavior ex.)a man discusses a murder he committed without showing any feelings toward himself or the victim

Symptoms of Schizophrenia Cognitive Deficits -difficulty sustaining attention -problems holding information in memory -inability to interpret information and make decisions -quiet and subtle symptoms -symptoms often only noticed through neuropsychological tests

Causes of Schizophrenia Biological Factors Heredity(Association of Genes with Schizophrenia) -partially caused by genetic factors -a genetic similarity to a person with schizophrenia increases risk of disease Structural Brain Abnormalities -MRI scans show enlarged ventricles in the brain ventricles:fluid-filled spaces, enlargement results in deterioration of other brain tissue -small prefrontal cortex and lower activity in this area of the brain -planning, decision making -people with schizophrenia lack glial cells Problems in Neurotransmitter Regulation -excess dopamine production -drugs reduce dopamine levels quickly but the delusional beliefs take much longer to disappear -time, experience, therapy

Abnormal Psychology & Therapy Project