Mental illness can occur when the brain or

Mental illness can occur when the brain (or part of the brain) is not working well or is working in the wrong way.

When the brain is not working properly, one or more of its 6 functions will be disrupted Behavior Thinking Perception Physical Emotion Signaling

Symptoms can include Thinking difficulties or problems focusing attention Extreme emotional highs and lows Sleep problems

When these symptoms significantly disrupt a person’s life, we say that the person has a mental disorder or a mental illness.

Well, the causes of mental illness are COMPLICATED!! + Genetics → Environment Brain Disorder

What do we know about the causes of mental illness? The symptoms of mental illness are a result of abnormal brain functioning. Mental illness is a brain disorder. Mental illness is rarely if ever caused by stress alone

What do we know about the causes of mental illness? It is not the consequence of poor parenting or bad behavior. It is not the result of personal weakness or deficits in personality. It is not the manifestation of malevolent spiritual intent. Only in exceptional cases is it caused by nutritional factors. It is not caused by poverty.

3 most common types of disorders • Anxiety disorders: People with anxiety disorders respond to certain objects or situations with fear and dread, as well as with physical signs of anxiety or panic, such as a rapid heartbeat and sweating. • Mood disorders: These disorders, also called affective disorders, involve persistent feelings of sadness or periods of feeling overly happy, or fluctuations from extreme happiness to extreme sadness • Psychotic disorders: Psychotic disorders involve distorted awareness and thinking.

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 • • 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 – – Isolation Withdrawal Apathy Blunted Emotional Expression • Negative symptoms are less influenced by medications than positive symptoms

What Causes Schizophrenia? • • 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 • • • 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

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-20 th 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

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

Treatment With all three of these illnesses, treatment, with the right combination of medications and/or therapy, can help stabilize the moods that interfere with a productive life.

Mental Health Treatment • There are three major types of treatment settings for people who have a mental health problem. Hospital Inpatient Residential Outpatient

• Hospital Inpatient hospitals provide treatment to more severely ill mental health patients. • They might be in the acute phase of a mental illness and need around the clock care • A stay in an inpatient setting is usually short term (less than 30 days)

Residential • Residential mental health treatment settings generally provide longer term care • chronic mental health problem • less "hospital-like" than an inpatient hospital

Outpatient • In an outpatient mental health treatment setting the client/patient does not spend the night or reside there. • Community mental health centers, hospital outpatient clinic, private offices