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Instructor: Kevin J. Armstrong, Ph.D.

Director, Clinical Psychology Training Program


Associate Professor & Licensed Psychologist

Research areas:
ADHD & externalizing disorders
Validity issues in diagnosis, assessment, and treatment

1 in ___ adults suffer from diagnosable mental disorders in
a given year
2003 2012
1. Anxiety Disorders 13.3% (18%)
2. Depressive disorders 9.5% (9.5%)
3. Addictive Disorders 6% *
4. Eating Disorders 2-5% ?
5. Schizophrenia 1.1% (1.1%)

(Numbers from NIMH web page, 2003 & 2012)
A recent study by the World Health Organization, the World Bank, and
Harvard University

Mental disorders account for ___ of the 10 leading causes of disability
in established market economies worldwide.
major depression
manic-depressive illness
schizophrenia, and
obsessive-compulsive disorder.

Other research has estimated that the cost of mental illnesses in the
United States, including indirect costs such as days lost from work,

was _______billion in 1990, the last time the total bill was measured.
NIMH (1999). http://www.nimh.nih.gov/publicat/numbers.cfm
For women:
More _________________ and _________________
disorders

For men:
More _________________ _________________

_________________ _________________
Chapter 1: Introduction and Historical Review

I. Introduction to the Study of Mental Disorders

II. History of Psychopathology

III. The Evolution of Contemporary Thought

IV. The Mental Health Professions
Study of the nature, development, and treatment of
psychological disorders

Challenges to the study of psychopathology:

Maintain objectivity

Avoid preconceived notions

Reduce stigma
Personal _________________
Emotional pain and suffering
Helplessness and hopelessness of depression
_________________
Impairment in a key area (e.g., work, relationships)
Chronic substance abuse results in job loss
Violation of Social _________________
Makes others uncomfortable or causes problems
Antisocial behavior of the psychopath
_________________
Wakefield's Harmful Dysfunction: failure of internal
mechanisms in the mind to function properly
Can the person, given the behavior pattern
in question, meet their life demands?

keep job/stay in school
maintain reasonable relationships with
family/friends
pay bills on time, stay out of jail
basically, can they handle their responsibilities
related to food, shelter, clothing, and
transportation?
Early Demonology
Possession by evil beings or spirits

_________________

Early Biological Explanations
Hippocrates (5
th
century BC)
Mental disturbances have natural (not supernatural)
causes (problems with the brain)
Three categories of mental disorders: mania, melancholia, &
phrenitis (brain fever)
Normal brain functioning depended on balance of four humors:
blood, black bile, yellow bile, & phlegm
Dark Ages (2
nd
century AD)

Monks cared and prayed for mentally ill

Witches (13
th
century AD)

_________________ sometimes led to bizarre delusional
sounding confessions, e.g., concourse with demons.

Initially, historians concluded many of the accused were
mentally ill.

Further research found little support for this conclusion.
Lunacy Trials
Trials held to determine sanity
Began in 13
th
century England

_________________ authorities assumed
responsibility for care of mentally ill

Lunacy attributes insanity to misalignment of
moon (luna) and stars
Asylums (15
th
century AD)
Establishments for the confinement and care of mentally ill

Priory of St. Mary of Bethlehem (founded in 1243)
One of the first mental institutions

The wealthy _________________ to gape at the insane

Origin of the term _________________(wild uproar or confusion)

Treatment non-existent or harmful at asylums
Benjamin Rush recommended drawing copious amounts of
blood, to relieve brain pressure
Philippe _________________(1745-1826)

Pioneered _________________ treatment at LaBicetre

Moral Treatment
Small, privately funded, humanitarian mental hospitals
Friends Asylum (1817)
Patients engaged in purposeful, calming activities (e.g.,
gardening)
Talked with attendants
Dorothea Dix Crusader for prisoners and mentally ill

Urged improvement of _________________

Worked to establish 32 new, public hospitals

Unfortunately, small staffs at these new public hospitals
could not provide necessary individual attention

Hospitals administered by physicians, who were more

interested in _________________ rather than psychological
aspects of mental illness
General paresis and _________________
Degenerative disorder with psychological symptoms
(delusions of grandeur) and physical symptoms
(progressive paralysis)
By mid-1800s, it was known that general paresis and
syphilis occurred together in some patients

In 1905, biological cause of syphilis found
Since general paresis had biological cause, other mental
illness might also

_________________ causes of psychopathology gained
credibility
Galtons (1822-1911) work lead to notion
that mental illness can be inherited

Nature (genetics) and _________________(environment)

_________________
Promotion of enforced sterilization to eliminate
undesirable characteristics from the population

Many state laws required mentally ill to be sterilized
Insulin-coma therapy
Sakel (1930s)

Electroconvulsive Therapy (___________)
Cerletti and Bini (1938)
Induce epileptic seizures with electric shock

Prefrontal lobotomy
Moniz (1935)
Often used to control violent behaviors; led to
listlessness, apathy, and loss of cognitive abilities

Mesmer (1734-1815)
Treated patients with hysteria using animal magnetism
Early practitioner of hypnosis (started with iron rods in bathtubs,
found he didnt need them)

Charcot (1825-1893)
His support _________________ hypnosis as treatment for hysteria

Breuer (1842-1925)
Used hypnosis to facilitate catharsis in Anna O.
Cathartic Method
Release of emotional tension triggered by reliving and talking about
event
Breuer and Freud (1856-1939) jointly publish,
Studies in Hysteria in 1895, which serves as the
basis for Freuds theory.

Freudian or Psychoanalytic theory

Human behavior determined by _________________ forces.

Psychopathology results from _________________ among
these unconscious forces.
Id
Unconscious

_________________ principle
Immediate gratification
Libido
Energy of ID

Ego
Primarily conscious

_________________ principle
Attempt to satisfy IDs demands within realitys constraints

Superego
The ____________________
Develops as we incorporate parental and society values
Id, Ego, & Superego continually in conflict

Conflict generates _________________

Ego generates _________________ to protect itself from anxiety

Defense mechanisms (see next slide)
Psychological maneuvers used to manage stress & anxiety
Goals of Psychoanalytic Therapy or Psychoanalysis
Understand early-childhood experiences, particularly key
(parental) relationships
Understand patterns in current relationships

Psychoanalytic Techniques
Free Association
Analysis of Transference
Interpretation


Jung (1875-1961)
Analytical psychology

Collective unconscious
Archetypes

Catalogued personality characteristics
_________________ vs. _________________

Adler (1870-1937)
Individual psychology
Fulfillment derived from working for the _________________
good
Childhood experiences help shape adult personality

There are _________________ influences on behavior

The causes and purposes of human behavior are

not always _________________
John Watson (1878-1958)

Behaviorism
Focus on _________________ behavior
Emphasis on _________________ rather than thinking or
innate tendencies

Three types of learning:
Classical Conditioning
Operant Conditioning
Modeling

Discovered by Pavlov (1849-1936)
Unconditioned Stimulus (UCS)
Meat powder (automatically elicits salivation)
Unconditioned Response (UR)
Salivation (automatic response to meat powder)
Neutral Stimulus (NS)
Initial ringing of bell (does not automatically elicit salivation)
Conditioned Stimulus (CS)
After pairing the NS and the UCS, the NS becomes a CS (bell now
automatically elicits salivation)
Conditioned Response (CR)
Salivation (automatic response to bell)
Extinction
CS (bell) not followed by UCS (meat powder) causes gradual
disappearance of CR (salivation)

2012 John Wiley & Sons,
Inc. All rights reserved.
E. Thorndike (1874-1949)
Learning through consequences

Law of _________________
Behavior that is followed by satisfying consequences will be repeated;
behavior that is followed by unpleasant consequences will be
discouraged

B.F. Skinner (1904-1990)

Principle of _________________

Positive reinforcement
Behaviors followed by pleasant stimuli are strengthened

Negative reinforcement
Behaviors that terminate a negative stimulus are strengthened
Learning by watching and imitating others
behaviors

Can occur _________________ reinforcement


Bandura & Menlove (1968)
Modeling reduced childrens fear of dogs

Behavior Therapy or Behavior Modification

Systematic _________________
Used to treat phobias and anxiety
Combines deep muscle relaxation and gradual exposure
to the feared condition or object
Starts with minimal anxiety producing condition and
gradually progresses to most feared

_________________ Reinforcement
Rewarding a behavior only occasionally more effective
than continuous schedules of reinforcement


Limitations of Behavior Therapy
How we think or appraise a situation influences our feelings and
behaviors

Cognitive Therapy
Emphasize how people think about themselves and their

experiences can be a major _________________ of psychopathology

Focus on understanding maladaptive thoughts

Change _________________ to change feelings and behaviors

Ellis (1913-2007)
REBT (Rational-Emotive Behavior Therapy)


Psychologists
Clinical or Counseling; Ph. D. or Psy. D.
Some states allow specially trained psychologists to prescribe
psychotropic medications

Psychiatrists
M.D.s can prescribe psychotropic medications

Psychiatric Nurses & Psychiatric Nurse Practitioners
Nurse Practitioners can prescribe psychotropic medications

Social Workers
M.S.W.
Not trained in psychological assessment

Masters Level Therapists & Counselors
MFTs (Marriage and Family Therapists)