Psychological Disorders
Schizophrenia
• Literal translation ‘split
mind’
• The most crippling of the
psychiatric disorders
• Costs more than all the
cancers combined
Nobel Prize
Winner John Nash
Subtypes of Schizophrenia
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Paranoid
Disorganized
Catatonic
Undifferentiated
Symptoms include:
Disorders of:
• thought (e.g., delusions & paranoia)
• language (e.g., incoherence, rhyming speech)
• perception (e.g., especially auditory hallucinations
– 70% of schizophrenics report hearing voices)
• blunted or inappropriate emotions
• strange or odd behaviors (e.g., facial grimaces)
Schizophrenia
• Positive symptoms
– Hallucinations
– delusions
– disorganized speech/behavior
• Negative symptoms
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Isolation
Withdrawal
Apathy
Blunted Emotional Expression
• Negative symptoms are less influenced by medications
than positive symptoms
What Causes Schizophrenia?
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Genetic
Environmental
Chemical/Biological
Brain abnormalities
Genetic Influences on Schizophrenia
Lifetime risk 40
of developing
schizophrenia 30
for relatives of
a schizophrenic
20
10
0
General
population
Siblings
Children
Fraternal Children
Identical
twin
of two
twin
schizophrenia
victims
Environmental Factors
• Identical twins don’t show 100% concordance, so
there must be an environmental component.
• Stress triggers potential risk & can make it worse (but
is hard to measure)
• Persons born in winter are more likely to develop
schizophrenia (but only in Northern climates)
• In years of influenza epidemics, babies born 3 months
later are at increased risk for schizophrenia (diagnosed
20 years later)
• Suggests one potential stressor is pre-natal
Biological bases
Evidence from
• brain scans
• studies using antipsychotic drugs
• drugs decreasing dopamine activity in brain reduce
severity
• drugs increasing dopamine in brain (e.g., L-dopa) can
produce schizophrenic-like conditions
• dopamine hypothesis: underlying cause of
schizophrenia is excessive stimulation of certain types
of dopamine synapses
Could you fool a psychologist into thinking that you are mad?
Probably!!
Experiment: David Rosenhan (1973)
Went to psychiatric hospitals & complained of 1
symptom:
• Heard voices: “empty” “dull” & “thud”
• Faked names & occupations
• Otherwise, honest about personal histories
All were admitted and diagnosed as paranoid schizophrenic (+ 1
manic depressive)
After admission, behaved normally & no longer complained of
auditory hallucinations
Their Question: “At what point would someone detect their
sanity?”
The Answer: “it never happened” (20 hospitals)
Even after study, hospitals persisted, releasing the pseudo-patients
with a diagnosis of “schizophrenia in remission”.
Perfectly normal behavior interpreted as consistent with the idea
they were abnormal
Rosenhan took notes – described as “writing behavior”
Patient said: “had a close relationship with his mother but was rather
remote from his father during his early childhood. During adolescence
and beyond however his father became a close friend while his
relationship with his mother cooled. His present relationship with his
wife was characteristically close and warm. Apart from occasional angry
exchanges, friction was minimal, the children had rarely been spanked.”
Clinician “explained”: “This white 39-year old male manifests a long
history of considerable ambivalence in close relationships, which begins
in early childhood. A warm relationship with his mother cools during
adolescence. A distant relationship to his father is described as becoming
very intense. Affective stability is absent. His attempts to control
emotionality with his wife and children are punctuated by angry
outbursts and in the case of the children, spankings. An while he says
that he has several good friends, one senses considerable ambivalence
embedded in those relationships also.”
Dissociative Identity
Disorder
• Formerly called Multiple Personality Disorder
– The presence of 2 or more distinct identities or
personality states that recurrently take control of
behavior.
– Each personality has its own memories, behavior
patterns and social relations
– Misconception:
• schizophrenia = having multiple personalities
Dissociative Identity Disorder
• Identities may have contrasting personalities which
may emerge in certain circumstances and may differ
in reported age and gender, vocabulary use, general
attitude and predominant affect.
• Time to switch between identities is usually only a
matter of seconds and often accompanied by visible
changes.
Thought experiment
• What are 3 of your biggest fears?
Specific Phobias
– Specific phobia types in DSM-IV
• Animal type (snakes, spiders)
• Natural environment type (heights, storms)
• Blood-injection-injury (BII) type (seeing blood, getting a
shot, watching surgery)
• Situational type (enclosed spaces, bridges)
• Other (vomiting, loud sounds, clowns)
Coulrophobia
More Phobias
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Myrmecophobia- ants
Phalacrophobia- becoming bald
Hobophobia-bums or beggars
Acrophobia-heights
Pentheraphobia- mother-in-law
Hypengyophobia-responsibility
Venustraphobia- beautiful women
Ailurophobia-cats
Gamophobia- marriage
Ophidiophobia-snakes
Arachnophobia-spiders
Hydrophobia- water
Adaptations to Predators and
Environmental Dangers:
Fears and Phobias
• Fears: snakes, spiders,
heights, separation,
darkness, strangers
• Responses: freeze, flee,
fight, submit
• Developmental timing of
onset of fears: coincides
with adaptive problems
Watch Clips on Phobias
Mood Disorders
• Major Depressive Disorder (Unipolar
Depression)
• Bipolar Disorder (Manic Depressive
Disorder)
Depression
• ‘Common cold’ of mental illness
• 17% lifetime prevalence
• Twice as common among women as men
– Bias in diagnosis?
– Self-medicating
• Depression much more common among
people born after mid-20th century (up to 3
times higher)
Depression
• Characteristics
– Persistent sadness, gloom
– Hopelessness, guilt, worthlessness
– Decreased energy, marked changes in
sleeping/eating
– Difficulty concentrating, restlessness
Depression
• Environmental factors
– ¾ of recently depressed individuals
experienced preceding negative life event
– However, only 1 in 5 experiencing
negative life event develop depression
Depression
• Cognitive features
– Negative view of themselves, the world,
and the future (cognitive triad)
– Attention turned inward (rather than
outward)
Depression
• Important Risk factors
– Low social support
– Low self-esteem
– Ruminative response style
– Physical/emotional illness
– Previous episode of depression
– Heredity
Depression
The vicious
cycle of
depression
1
Stressful
experiences
4
Cognitive and
behavioral changes
2
Negative
explanatory style
3
Depressed
mood
Mood Disorders
• Bipolar Disorder (Manic Depression)
– Characterized by dramatic mood swings—from
overly "high" and/or irritable to sad and hopeless,
and then back again, often with periods of normal
mood in between
• Depressive episode: usual symptoms of depression
• Manic episode
• Increasing rates of teen suicide
• 1% prevalence
Bipolar Disorder
• "Manic-depression distorts moods and thoughts, incites
dreadful behaviors, destroys the basis of rational
thought, and too often erodes the desire and will to live.
It is an illness that is biological in its origins, yet one
that feels psychological in the experience of it; an
illness that is unique in conferring advantage and
pleasure, yet one that brings in its wake almost
unendurable suffering and, not infrequently, suicide. “
-- Kay Redfield Jamison, Ph.D., An Unquiet Mind, 1995
Bipolar Disorder
• Approximately 1 in 5 die
from suicide
• Highly heritable
– 70% concordance rate for MZ
twins, 20% for DZ
Bipolar Disorder
• PET scan of bipolar brain
Depressed state
Manic state
Depressed state
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