Analyzing Psychological Disorders
Jeannie Hopkins
PSY/240
11/17/2013
Dr. Brooke Morford

A psychological disorder is known as a mental disorder; it is a pattern of behavioral or psychological symptoms that impact multiple life areas and/or create distress for the person experiencing these symptoms. According to the National Institute of Mental Health (NIMH), approximately 26 percent of American adults over the age of 18 suffer from some type of diagnosable mental disorder in a given year (The Numbers Count: Mental Disorders in America). Almost half of that also meet criteria for 2 or more disorders, with severity strongly related to comorbidity. Mental disorders are diagnosed based on the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) here in the U.S.
The DSM-IV-TR explains that a multiaxial system involves an assessment on several axes, which refer to a different domain of information that may help the clinician plan treatment and possibly predict the outcome (Association, 2000). The five axes included in the DSM-IV multi-axial classification are as listed: * Axis I: Clinical Disorders and Other Conditions That Need Clinical Attention. * Axis II: Personality Disorders and Mental Retardation. * Axis III: General Medical Conditions. * Axis IV: Psychosocial and Environmental Problems * Axis V: Global Assessment of Functioning Scale (GAF).
As stated in the DSM-IV-TR “the Global Assessment of Functioning Scale is a 100-point scale that measures a person’s overall level of psychological, social, and occupational functioning on a continuum” (Association, 2000).
Schizophrenia is a chronic, disabling mental illness characterized by a wide range of symptoms, including: abnormal thinking, loss of contact with reality, and hallucinations. This illness usually starts in late adolescence or early adulthood, and may also continue into years of gradual social and academic deterioration. It is a disorder characterized in general by fundamental and characteristic distortions of thinking and perception (Phillip W. Long, 1995-2009). Schizophrenia is a psychosis in which a person cannot tell what is real from what is imagined. They hear voices that other people don't hear and believe people can read their mind and even control their thoughts. A sudden change in personality and behavior occurs when this happens and they lose touch with reality, this is called a psychotic episode (Schizophrenia Health Center. Schizophrenia: An Overview, 2005-2013).
Long explains that “in the development of schizophrenia, the earliest structural deficits in the brain are found in parietal brain regions, supporting visuospatial and associative thinking” (Phillip W. Long, 1995-2009). It is also explained in the National Institute of Mental Health that scientists think an imbalance in the complex, interrelated chemical reactions of the brain involving the neurotransmitters dopamine and glutamate, and possibly others, plays a role in schizophrenia (The Numbers Count: Mental Disorders in America). Research has also shown there is significant loss of brain mass in schizophrenia patients and disruption of connection within the brain. These underlying neurological lesions are believed to cause the cognitive impairments that are the main features of schizophrenia such as impaired executive functioning, cognitive slowing, apathy, memory impairment, and poor concentration (Phillip W. Long, 1995-2009).
Sadly, causes of schizophrenia are still unknown so treatments focus on eliminating the symptoms of the disease which include antipsychotic medications and various psychosocial treatments (The Numbers Count: Mental Disorders in America). Antipsychotic medications were introduced in the mid 1950’s and are usually in pill or liquid form. However, some anti-psychotics are shots that are given once or twice a month. The most commonly used antipsychotic medications are Chlorpromazine (Thorazine), Haloperidol (Haldol), Perphenazine (Etrafon, Trilafon), and Fluphenazine (Prolixin). Psychosocial treatments help with those who are already stabilized on antipsychotic medication. Psychosocial treatments help them deal with the everyday challenges of the illness, for example, difficulty with communication, self-care, work, and forming and keeping relationships (The Numbers Count: Mental Disorders in America). Patients are also more likely to continue taking their medications when they receive regular psychosocial treatment.
Rus-Calafell (2013) explains in his article that ameliorating social impairment has become one of the most important challenges when treating patients with schizophrenia (Mueser & McGurk, 2004). This was once described as the conjunction of disabilities in social cognition and social competence. Social skills training (SST) interventions aim to improve the patient's social functioning and are one of the treatments of choice in schizophrenia spectrum disorders (Rus-Calafell, 2013). Granted this type of treatment is usually done in groups, which allows the participants to practice with others, it can be done individually.
In one of our cases to analyze is a well-known disorder, anorexia nervosa. This is an eating disorder in which people have an intense fear of gaining weight and can become dangerously thin (Anorexia Nervosa Health Center, 2005-2013). This disorder is also the most lethal psychiatric disorder, carrying a six fold increased risk of death, four times the death risk from major depression. Watson and Bulik explain in their article that “anorexia nervosa is a potentially deadly psychiatric illness that develops predominantly in females around puberty but is increasingly being recognized as also affecting boys and men and women across the lifespan” (Watson & Bulik, 2013).
NIMH explains that an eating disorder is an illness that causes serious disturbances to your everyday diet, such as eating extremely small amounts of food or severely overeating (The Numbers Count: Mental Disorders in America). Eating disorders generally coexist with other illnesses such as depression, substance abuse, or anxiety disorders. Studies also show eating disorders run in families. As the restrictive patterns of eating began to set in with Beth as a teen, the positive-incentive value of food started to rise (Pinel, 2007). Beth's desire for food increased because of the increased cephalic-phase insulin response which inevitably led to a binge and fast cycle.
The classic Nature vs. Nurture debate is evident in causes of eating disorders. The nature role is where the media plays a detrimental role in our environment, and can cause people to feel inadequate with their body image. People argue that it is their environment that shows them how to be a certain way. In the case with Beth, she feared as a teenager of being overweight, probably from pressure from school and magazines. The nurture role on the other hand is where some may say that people who develop eating disorders are genetically predisposed to having one develop in them.
Granted some who have anorexia nervosa recover with treatment after only one episode, others may get well, but have relapses. In the more extreme cases like Beth’s with a more chronic, or long-lasting, form of anorexia nervosa their health declines as they battle the illness (The Numbers Count: Mental Disorders in America). All people with anorexia need treatment; this generally involves psychological counseling such as seeing a doctor and having regular counseling sessions. Those seriously underweight as Beth and who have severe medical problems need to stay in a hospital until they restore a healthy weight and healthy eating habits.
Another disorder that affects our population is insomnia. Sleep apnea is one of the causes of insomnia. This refers to a condition in which a person, while sleeping, stops breathing many times during the night. This can be caused by atonia which is loss of muscle tone (Pinel, 2007, p. 392). An article written by Okajima (2013), explains that “nearly 20% of the general adult population has been reported to have insomnia (Mellinger et al., 1985, Ancoli-Israel and Roth, 1999 and Kim et al., 2000). He also goes on to explain that pharmacotherapy and cognitive behavioral therapy for insomnia (CBTi) are the most often prescribed treatments for insomnia (Okajima, 2013). In a clinical trials study it is stated that, “sleep occurs in much of the animal kingdom, in all mammals and birds and even in some lower forms” (Regional Rates of Cerebral Protein Synthesis: Effects of Sleep and Memory Consolidation, 2013). There is also evidence that learning and memory are helped by sleep, and that the synthesis of proteins in the brain are involved.
Insomnia is a sleep disorder that is characterized by difficulty falling and/or staying asleep. People with insomnia generally have difficulty falling asleep, waking up often during the night and having trouble going back to sleep, waking up too early in the morning and/or feeling tired upon waking. According to WebMD (2005-2013), there are two types of insomnia: primary insomnia and secondary insomnia. Primary insomnia is when a person is having sleep problems that are not directly associated with any other health condition or problem. However, secondary insomnia is when they are having sleep problems because of something else, such as a health condition (like asthma, depression, arthritis, cancer, or heartburn); pain; medication they are taking; or a substance they are using (like alcohol).
Causes of acute insomnia may include significant life stress such as job loss or death of a loved one. Other known causes are illness, emotional or physical discomfort, environmental factors like noise, light, or extreme temperatures (hot or cold) that interfere with sleep (Sleep Disorders Health Center, 2005-2013). Causes of chronic insomnia may include depression and/or anxiety, chronic stress, and pain or discomfort at night. Symptoms to notice if you think you have insomnia would be sleepiness during the day, general tiredness, irritability, and/or problems with concentration or memory.
According to Hopkins, insomnia is so common that it may very well run in families, just like diabetes and heart disease (John Hopkins Medicine, 2009). A study published in the journal “Sleep” reported that people who have experienced insomnia are more likely to have a close relative with the condition. However, there is also evidence that people with bad sleep habits tend to transmit them to their children. In the other case I am analyzing with Mary, she seems to have insomnia and with being a single mom, it can be difficult for her to maintain. Acute insomnia may not require treatment. However, treatment for chronic insomnia includes treating any underlying conditions or health problems first that may be causing the insomnia. If insomnia continues, behavioral therapy may be prescribed for the patient. Since Mary’s doctor does not want to prescribe her with sleep medication, techniques such as relaxation, exercises, sleep restriction therapy, and reconditioning may be helpful to her.
In conclusion, factors of these disorders vary widely, as do the treatments. The one common factor between them is depression. Apparently the development of primary depression predisposes a person to insomnia, anorexia, and schizophrenia. Even with these disorders having a neural explanation, nature does not always rule human behavior. In the majority of the disorders mentioned, genetic factors only predispose a person to a particular disorder when environmental factors seem to play an integral part in the actual onset of the disease.
REFERENCE PAGE:
Anorexia Nervosa Health Center. (2005-2013). Retrieved from WebMD: http://www.webmd.com/mental-health/anorexia-nervosa/default.htm
Association, A. P. (2000). Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR). Arlington, V.A.: American Psychiatric Publishing. Retrieved from http://dsm.psychiatryonline.org//book.aspx?bookid=22
John Hopkins Medicine. (2009). Retrieved from Johns Hopkins Health Alert: http://www.johnshopkinshealthalerts.com/alerts/depression_anxiety/JohnHopkinsDepressionAnxietyHealthAlert_3144-1.html
Okajima, I. (2013). Cognitive behavioural therapy with behavioural analysis for pharmacological treatment-resistant chronic insomnia. Psychiatry Research, 210(2), 515-521.
Phillip W. Long, M. (1995-2009). Internet Mental Health. Retrieved from http://www.mentalhealth.com/p20-grp.html
Pinel, J. P. (2011). Biopsychology, Eighth Edition. Allyn & Bacon.
Regional Rates of Cerebral Protein Synthesis: Effects of Sleep and Memory Consolidation. (2013). Retrieved from ClinicalTrials.gov: http://www.clinicaltrials.gov/show/NCT00884702
Rus-Calafell, M. (2013). A virtual reality-integrated program for improving social skills in patients with schizophrenia: A pilot study. Journal of behavior therapy and experimental psychiatry, 81-89.
Schizophrenia Health Center. Schizophrenia: An Overview. (2005-2013). Retrieved from WebMD: http://www.webmd.com/schizophrenia/guide/mental-health-schizophrenia
Sleep Disorders Health Center. (2005-2013). Retrieved from WebMD: http://www.webmd.com/sleep-disorders/guide/insomnia-symptoms-and-causes
The Numbers Count: Mental Disorders in America. (n.d.). Retrieved from National Institute of Mental Health: http://www.nimh.nih.gov/health/publications/the-numbers-count-mental-disorders-in-America/index.shtml
Watson, H. J., & Bulik, C. M. (2013). Update on the treatment of anorexia nervosa: review of clinical trials, practice guidelines and emerging interventions. Psychological Medicine, 43(12), 2477-500.