|Diagnostic and Statistical manual of
Axis 1 - Clinical disorders
Axis 2 - Personality Disorders
Axis 3 - General Medical Conditions
Axis 4 - Psychosocial/Environment
Axis 5 Global Functioning
Benefit: - universal classifications of a
Draw Back Stigmatize a person.
Tools of the insurance
Example of a persons Assessment
Axis I mood disorder
due to hyperthyroid
Axis II No diagnosis
Axis III Hypothyroidism
Axis IV None
Axis V 45 (1-100) worked their way up to a 65 on discharge.
91 100 perfect handling of their life.
NOTE TO STUDENTS: MEMORIZE DISORDERS BY CLASS
Phobic Disorders (phobia fears)
Irrational Fears for example the fear of balloons.
it is possible to treat a fear whether or not you know where it came from.
Claustrophobia - fear of small places
Acrophobia fear of heights
to a Phobia
Reducing most of your fear all at once
Facing your fear all in one day
First applied in late sixties.
Freud believed that these phobias were related to the first years of life, some problem
with one of the first stages of psychosexual development
Symptom substitution - When you loose one fear you
replace it with another
Freud - found to be false.
An additional fear is that of
be a conditioned fear - fear that you will have a
panic attack out in a public place - you then fear
even going out all.
being in a situation from which you might not escape
or might be difficult
fear of situations
that may lead to embarrassment
Tranquilizers not to be longer than a 3 month
period. because they are addictive.
Gaba inhibitory neurotransmitter
or the valerian
root increases (corrected 3/13/01) Gaba transmission
Obsessive compulsive disorder
Some people will be obsessive compulsive
about washing hands they ll wash so much
that their hands chap and bleed.
This can be treated with SSRI example to treat
OCD is clomipramine
Serotonin Re-uptake Inhibitors example
a 1 in 100 chance in getting OCD
adult hood comes around, women to men is roughly equal.
post traumatic stress disorder.
nightmares are a symptom of PTSD
It is possible
that the trauma causes physical changes in the brain...
some people are susceptible to having this reaction.
not all people that undergo a trauma end up with PTSD
some of the changes are in the hypocampus
- involved in memory.. it decreases in size for people
who come down with PTSD during war time.
Some people ARE more vulnerable to stress than others.
should have a social support network.. so that they
Seasonal Affective Disorder
Uni-polar (depression) only during a certain season
typically during the beginning of winter until
beginning of summer.
Caused by light exposure and the corresponding
melatonin release. primarily found in the northern
and southern extremes of the globe.. from about Washington
state North but rarely around the equator
(Click here to go to description)
Mild Uni-polar Depression
(Click here to go to description)
Cyclothymia mild mood swings
Taking too much melotonin can make you depressed
seasonal depression -
increase the amount of daylight that you have
(artificially) or move towards the equator.
Psychology IF it interferes with a persons life, then its a problem
Sever winter depression living in high latitudes
Wanting to sleep lots
in the back of the eyes, there is a structure which tells the body whether or not it is
day or night.
The lights help to take a person out of hibernation..
Depression - DSM - IV criteria (5 or more symptoms over a 2 week period)
- Depressed mood
- Diminished interested or pleasure (anhedonia)
- It's hard to help a depressed person because they aren't really that responsive.
- Weight or appetite increase or decrease
- Sleeping too much or too little
- Feeling either agitated or physically slowed
- Loss of energy
- Feelings of worthless ness or guilt
- Difficulty concentrating or making decisions
- Thoughts of death or suicide
Uni-polar depression continued
Left frontal love = Approach/joy
right frontal lobe = withdrawal/distress
underachieve left frontal EEG in adults and in
Uiversity of Washington Research (Dr. Dawson)
Children of mothers: frontal EEG activity during play at one year of
age left lobe activity is about equal to right lobe activity
children of non-depressed mothers: left is greater than right.
Treatment of uni-polar depression
- low levels of norepinephrine and or serotonin
- Biochemical treatments raise these neurotransmitters
- Amino acids: phenylalanine and or tyrosine can raise norepinephrine
- 05 -hydroxy-tryptophan can raise serotonin
- St. John's Wort (a herb) can raise serotonin
MAO - Inhibitors raise both norepinephrine and serotonin
you need MAO to have an
reaction to tyromines
so if you have an inhibitor, you may wish to not eat certain foods
SSRI'S (selective serotonin re-uptake inhibitors) raises serotonin (e.g., Prozac,
9-26% females lifetime will get uni-polar depression
5-12% males will get uni-polar depression
for both m/f only 1 % will come down with Bipolar disorder.
ECT (Electro Convulsive Shock
Therapy) Seizure induction creates a form
of amnesia, and helps to dissipates the depression report
have permanent in memory.
there is no major brain damage.
Prozac makes some people worse.
Depressed family vociferous
Medications have their limitations.
Prozac will not change everything.. simply help
people become more functional in society.
Prozac is a part of life, not just a medication
End of Movie Notes.
DSM IV Criteria for Mania (Bipolar)
- Elevated, expansive, or irritable mood
- Inflated self-esteem
- Decreased need for sleep
- More talkative than usual
- Feeling that thoughts are racing
- Easily distracted
- More activity
- Negative outcomes (e.g. gambling shopping)
Certain families only would suffer from
Genetic markers for depression on chromosome
#11 on the short arm.
First line of defense of manics are lithium and anticonvulants
The transmitters involved are norepinephrine and seritonin
Manic is associated with norepinephrine
Treatment of Manic Depression: You need to treat both manic and depression stage. You
need lithium, to add seritonin re-uptake inhibitors to prevent recycling into mania.
These medications have side affects
Lithium and anticonvulants nausea,
lowering immune system, and liver affects when the dosage is too high.
The use of cannabis as a mood stabilizer in bipolar disorder: anecdotal
evidence and the need for clinical research
By Lester Grinspoon, MD. And James B Bakalar
The authors present case histories indicating that a number of
patients find cannabis (marijuana) useful in the treatment of their bipolar disorder. Some
used it to treat mania, depression or both. They stated that it was more effective than
conventional drugs, or helped relieve the side effects of those drugs. One woman found
that cannabis curbed her manic rages: she and her husband have worked to make it legally
available as a medicine. Others describe the use of cannabis as a supplement to lithium
(allowing reduced consumption) or for relief of lithiums side effects. Another case
illustrates the fact that medicinal cannabis users are in danger of arrest, especially
when children are encouraged to inform on parents by some drug prevention programs. An
analogy is drawn between the status of cannabis today and that of lithium in the early
1950s., when its effect on mania had been discovered but there were no
controlled studies. In the case of cannabis, the law has made such studies almost
impossible, and the only available evidence is anecdotal. The potential for cannabis as a
treatment for bipolar disorder unfortunately can not be sully explored in the present
Psychosis involves loss of contact with reality, symptoms included:
- Disorganized and deluded thinking
- Disturbed perceptions (hallucinations)
- Inappropriate emotions and actions
Neurotic = maladjusted
Psychosis = such a large discrepancy with reality, the person actually has problems
serving while in a schizophrenic episode
Delusions: false beliefs not based on reality
Hallucinations: perceptions in the absence of sensory stimulation, often hearing non
Schizophrenics are near impossible to hypnotize because their attention is not able to
(s)he = she or he
Since when a person thinks, (s)he is almost talking to (his)herself.
If a schizophrenic is thinking, (s)he may think that when (s)he hears
(his)her own thoughts (vividly) (s)he will think that (s)he is hearing voices.
Movie Notes: on schizophrenics
10% will suicide in 10 years
15% will not respond to the medication
End of Movie
- Positive symptoms: talk is disorganized and deluded, emotional expression (e.g.,
laughter, tears, or rage) often inappropriate
- Negative symptoms: toneless voices, expressionless faces (flat affect), or mute and
Discrimination between Chronic and Acute
- Chronic (process) develops gradually
- Acute (reactive) develops rapidly in response to particular life stresses
Movie Notes -
Hipocampus some clear cut organic pathological changes
the nerve cells
are usually lined up like slats of a picket fence.. but in schizophrenics, these slats are
in "every which way" during 2nd trimester (possibly due to
These cells are supposed to migrate during the 2nd trimester. but they
dont completely migrate.
The flue virus has a special enzyme that has neuro menedase, specifically affects the
adhesive ness of these nerve cell adhesion molecules.
Normal: Lined up, dendrites are organized.
abnormal: Neruons are all over, and the dendrites are located in every direction
Agent thorozine (promozine) anti psychotic drugs normalize the
chemistry of the brain.
Anti-psychotics drugs reduce the dopamine activity.
Schizophrenia is in theory too much dopamine
End of Movie Note
Biological observations include
Increased receptors for dopamine
Frontal lobe under activity
Enlarge ventricles (less cerebral tissue)
Mid-pregnancy viral infection of the fetus
is related to stress and to double-blind situations.
Drugs that decrease dopamine (chlorpromazine (thorazine),
Skills training, family support
Tardive dyskenisia can be a side effect of chlorpromazine
Example: Parkensisns not having enough dopamine
Command hallucinations are some of the worse
- inability to recall important personal information
- that is traumatic or stressful
- not due to other disorders
(e.g., post tramatic stress)
- causes distress or impairment
- Sudden unexpected travel from home with inability
to recall ones past
- Identity confusion or new or partial identity
- Not due to drugs or dissociative identity disorder
- Causes distress or impairment
When ones identity returns there is no memory
of fugue state
Dissociative identity disorder
- two or more distinct identities each has its own patterns of perceiving, thinking
- inability to recall personal information (not explained by ordinary forgetfulness.)
Dissociative Identity Disorder
Loss of childhood memories
Stress can trigger identity switches
Half of cases have 10 or fewer identities
Patients score high on measures of
Several times more likely in adult females than
Differences in acting vs. "The real thing"
Different for each personality
Movie Notes (multiple personalities)
When another personality, there is now way to retake control
Childhood is when DID begins.. because a
child feels they need to flee from psychological or sexual abuse.
The brain is constantly
generating activity, if you stimulate the person with a should, sight or shock, you get a
vot: vot potential - used in EEG
Each personality can show different brain wave patterns.
Heart rate, cerebral blood flow
Movie Notes: Intro to tomorrows Therapy Lecture
A problem that interferes with life
Psychotherapy helps to resolve problems that interfere with life.
- Providing a safe relationship
Support: helps the therapeutic alliance
Suggestion helps to bring out symptoms
Clarification of what must be dealt with
<outbursts at a person transference reaction>
Flux flexible enough to display positive signs of advancement.
Encouragement from the psychotherapist
Dissociative identity Disorder continued
Hostile, controlling, or protective personalities
have more complete memories passive itdentiies
identities can didffer in usual acuity, pain tolerance,
allergy symptoms, insulin response
it's a strange combinateon between a real disorder
it is possible that a child developes multiple personalities
as a defense mechanism, if the child does not shed
this habit, it can become a disorder when they are
One potential for this disorder is that people simply
"fake it" and are trying to get attention
there are a number of personality disorders that may
impare one's social functioning
Two examples are:
Borderline personality involves unstable
identity; emotions and relationships
Antisocial personality involves lack
- unstable relationhsips (high rate
of suicide - self muulation kinds of things)
Antisocial - similar - psychopath
1% of the
population has these anti social tendencies, and they
don't feel empathy as most people do, less guilt
Asburger syndrome - similar in the sense that it doesn't
allow for empathy
Psychopaths don't process sounds
on the left as the rest of us,
equally on each side of the brain.
responds to the stimulus of emotional words and other
Also psychopaths have been described as machines.
able to rationalize behavior
Very difficult to study a psychopath..
simple description - they are wired up differently
END OF MOVIE NOTES
True gestalt theory was absent
Psycho analysis is so epileptic - (pulls in ideas from
The therapist listens to the client
SHUT UP and
that you understand what they are saying, Ask "is
that you said?"
cues of what you want to hear!
Psychotherapy - goal - increases self
- Psychotherapy is education
- Education can mean learning a new viewpoint, new information, or practicing a new skill
- 1.) Insight
- 2.) New information
- 3.) Skill development
- 4.) feed back and support
Two key concepts are:
- Transference patterns of relating from previous relationships are
repeated and transferred to the therapist
Resistance an important part of therapy - the client subverts the
therapeutic process to avoid threatening material.
There are three primary ways of dealing with resistance
- Confront the resistance - hit it head on, make the patient see their own resistance.
- Dodge the resistance It will come up again later in the session
- Support the resistance Increase security, so the client resists less (in a
Cognitive Albert Ellis, Aaron Beck
Systematic desensitization Mary
Humanistic Therapy Creation of an informative session where the person
Gestalt therapy constant confrontation
Hakomi resistance is dealt with in a different way than gestalt therapy
- Establish mindfulness (similar to a meditative state)
Very present moment focus like gestalt
- It supports the resistance.
Helps the patient in resisting the therapy, therefore making the client feel more secure
and more willing to confront threatening material.
In Hakomi the idea is to increase security:
"if you want to fight me, Ill help you
fight me so you no longer feel threatened"
supporting of the patient
Binge Eating followed by either
- Excessive exercise
Can be any weight
- About 5% of high school females
- About 14% of college females (seniors)
- Often appears with depression
- Self induced starvation
- Abnormal fear of being fat feeling fat even though
they are thin. (distorted body image).
- About 1% of adolescent females
80% to 90% of bulimic and anorexic
In an experiment where there were 3 schools,
all of which had a littering problem, there were 3 methods
of handling the situation.
- Scolding the children in an assembly
showed no true signs of improvement.
- Giving rewards for throwing away trash
Worked while the system was in place
After returning to the school 6 months later, the
students returned to their previous habits.
- Supporting the children, praising them for not littering
(even though they do litter)
Worked because it changed the mind set of the children
After 6 months they continued to refrain from littering,
because of the change in the mindset.
Stress is physiological response to noxious stimuli.
- Enlarged adrenal Glands
- Reduced thymus
- Ulceration of the Stomach
Stress is affected by ones appraisal of the Situation. What is stressful
verses challenging varies across individuals
General adaptation syndrome (Hans Selye)
- Alarm reaction
Effects if stress:
Can increase adrenaline and norepinehprine
Reduces the number of lymphocytes
General Adaptation Syndrome (Hans Style)
Gluco-cordacoides are released from a gland near Kidney causes
stress too much exposure may destroy brain cells
End of Movie Notes
Theory from some new research is that:
Stress early in life can reduce the size of the hypocampus.
Verses the idea of stress killing brain cells.
how the brain re-grows it self
Things that suppress the immune system:
- Sleep Deprivation
- Learned helplessness
- Bereavement i.e. any loss (e.g., friend, intellectual skills, memory, self esteem, home,
land, physical attractiveness, status)
- Death of Spouse 100
- Financial Change 38
Factors that influence stress are:
- Perceived control (eg. Dentist, nursing home study)
being told by your physican that there will be a certain type of pain for a limited
amount of time, the fact that you know reduces your stress.
An experimental example would be:
There would 2 rats
- Motivation - less modivartion = more stress
- Physiological State - going through surgery, and if you have psycho logical stress -
divorce, the 2 will add together
- Social Support - the more social support/friends the less stress you will experience.