Please click the image to view the complete infographic. Source: NAMI

Source: Schizophrenia.com

Forceps

Module 6

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Module 6: Individual Differences: Personality and Psychopathology

Tuesday, August 8 – Monday, August 14

Required

Reading/Viewing:

Principles of Psychology, Chapters 12 and 13 (Pages

502-516; 521-538; 549-563; 568-572)

Module 6 online content

Discussions: Module 6 Discussion

Initial responses due Friday, August 11, 9:00

AM ET

Two peer response due Monday, August 14,

9:00 AM ET

Leader response due Wednesday, August 16,

9:00 AM ET

Assignments: None

Assessments: None

Live Classrooms: Tuesday, August 8, 7:30–9:00 PM ET

Activity: Complete Module 6 Review and Reflect, due

Tuesday, August 15, 11:59 PM ET

Welcome to Module 6

cas_ps101_19_su2_mtompson_mod6 video cannot be displayed

here

QUESTION 1 OF 4

Based on the video, determine if these statements are true or false.

1. Mania is typically characterized by high-energy, elated mood, and excessive confidence.

TRUE FALSE

CHECK ANSWER

VIDEO FOLLOW-UP

Learning Objectives

1. Describe the epidemiology of mental health disorders, including overall prevalence of disorders, the most common disorders, and overall

differences between men and women.

2. List symptoms of schizophrenia.

3. List symptoms of depression.

4. List symptoms of mania.

5. Describe the vulnerability-stress model and give examples of particularly important types of stressors for depression.

6. List three providers of mental health services and the differences in their training.

7. Describe three major approaches to the treatment of mental health disorders.

8. Compare and contrast the legal notions of “competence” and “insanity.”

Abnormal Psychology

Defining Mental Disorders

In this area of psychology, we are interested in understanding how mental disorders display themselves, how they emerge, what factors determine

them, and how to best treat them.

A psychological disorder, or mental disorder, is a pattern of behavioral and psychological symptoms that either (a) impairs one’s ability to

function in important areas of life AND/OR (b) causes significant distress. I want you to remember this definition. One can be “odd” and certainly

not have a mental disorder. It needs to be a pattern of behavior, and it needs to involve impairment in functioning or significant distress (or both).

The DSM-5 is the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, a book published by the

American Psychiatric Association (APA) that lists current diagnoses of psychological disorders and describes them.

It’s helpful in that it provides a common language to help professionals communicate and provides guidelines for

making diagnoses. It helps convey information between professionals and it helps us study mental disorders by

operationalizing them for research.

Epidemiology of Mental Disorders

So how common are mental disorders? Well, there’ve been a number of large epidemiologic studies. An epidemiologic study investigates how prevalent

(how common) a problem is in a particular population or society and what some of the risk factors might be (at a population level). There are many

large epidemiological studies to examine heart disease, diabetes, and many other health conditions. There have also been some large epidemiologic

studies of mental disorders in a number of countries. So here are some surprising findings from those studies. First, mental disorders are quite

prevalent. Approximately 50% of people will experience a mental health disorder in their lifetimes. Do you find this surprising? There’s such a range of

mental health problems, substance use problems (including what we used to call addictions), depression, anxiety, and a host of others. It should be

noted that available data suggest that rates of mental health disorders went UP during the COVID-19 pandemic. Please click on the image below to see

clearly the extent of some mental health problems in the United States.

At least in the United States addictions are among the most common, as are depression and anxiety.

Schizophrenia, which I’ll talk about more about later, is a much less common mental health problem.

Second, most people with a mental health problem about 80% do not receive any treatment from a

mental health professional! That’s a lot of people. So why don’t people get treatment? Well,

here are some reasons:

1. Many people may recover on their own without help. They may not be seriously debilitated and they

will get better over time. After all, if you think about a lot of illnesses, how often do you not seek

treatment and just “wait it out”? Many of us have had “flu-like symptoms” and not gone to the

doctor; we then got better over time. This can be true of mental health disorders too (at least more

mild forms). Maybe you also seek help from people in your life who can provide support, guidance,

and input, and these all help in your recovery.

2. On the other hand, we know that many mental health disorders can be chronic, and people may

need help even though they don’t seek it out. One reason they don’t seek it out may be because of a

“pull yourself up by your bootstraps” attitude, which is particularly prevalent in America. The idea

here is that you need to “tough it out,” just fix it yourself, or “get over it.” Sadly, this attitude leads

people to suffer in silence and keeps people from reaching out for help that could lead them to

recover more quickly.

3. Stigma can also be a really big problem. Mental health problems are often perceived as a personal

flaw or sign of weakness, and people may be ashamed to seek help for their problems. There’s a lot

of stigma in our society. Some years ago research was done to look at mental health stigma and

television programming. Interestingly, evaluating prime time television programs yielded two types

of characters who have mental health problems and frequently show up in storylines. The first is the

helpless individual (e.g., think about the homeless woman who gets murdered early in an episode of

Law & Order). The second, and perhaps more problematic, character is the dangerous mentally ill murderer (think of many old movies). These are

pretty negative stereotypes that don’t really encourage people to acknowledge their mental health challenges and seek help! Nor are these

stereotypes accurate! Unfortunately, these stereotypes can often be associated with discrimination. In recent years, laws have come on the books

to forbid discrimination against people with mental health problems, and I think this is a good thing.

One thing we do know is that men and women may differ in the prevalence of certain kinds of mental health problems. In general, women have higher

rates of depression and anxiety, and men have higher rates of alcohol and drug problems. This is not to say that women can’t have drug and alcohol

problems and that men can’t have anxiety and depression! Both certainly can have each (and possibly both), but the relative prevalence differs

between men and women.

* All other groups are non-Hispanic or Latino ** NH/OPI = Native Hawaiian/Other Pacific Islander ***AI/AN = American Indian/Alaska Native Source: NAMI

So let’s talk about some specific mental health problems.

Schizophrenia

Schizophrenia is often what people think about when they think of mental illness. Schizophrenia is a severe mental illness in which individuals

experience a number of symptoms. Let’s talk about some of those symptoms. Symptoms of schizophrenia are generally divided into two categories:

positive symptoms and negative symptoms.

Positive Symptoms

What are positive symptoms? By positive symptoms we don’t mean good symptoms, rather positive symptoms are excesses or additions to normal

experience.

Hallucinations are odd perceptual experiences. Hallucinations can occur in many of our perceptual systems. In visual hallucinations, people see

things that aren’t really there. They may have visions. I used to work with children who had schizophrenia, which is a very rare condition in

childhood. Some of these children would complain of images in their environment, the presence of people who weren’t there, and other odd

visions. In olfactory hallucinations, people smell things that aren’t there, including odd odors. Now usually these odors are not pleasant, like

roses; they’re more likely to be awful things, like feces. One of the things we’ve learned about olfactory hallucinations is that they may be signs of

a brain tumor. So, if someone came into the emergency room with olfactory hallucinations, it might be best for the doctors to give them a brain

scan to make sure they didn’t have a brain tumor. In tactile hallucinations, people often feel like there is something crawling on their skin or

touching them in some way. Tactile hallucinations have been known to occur in people who are using a lot of amphetamines. So maybe they’re

taking speed to get high and they begin to experience these tactile hallucinations, reporting that they have the sensation that insects are crawling

on their skin. In auditory hallucinations, people hear things that aren’t there. They may hear people talking to them or about them; they may hear

noises or conversations that don’t exist. Auditory hallucinations are the most common type of hallucinations in schizophrenia. I can remember

many patients I saw over the years. I remember one who startled me in the middle of our conversation when he turned around and screamed,

“Shut up, Mary!” at something behind him. Clearly he was hearing a very bothersome voice (auditory hallucination), which he was then able to

describe to me.

Delusions are false beliefs. I used to work at a Veterans Administration hospital and interview people with schizophrenia. I also traveled all over

Los Angeles when I was completing my doctoral dissertation research, and I interviewed many individuals with schizophrenia about their

experiences. I was particularly interested in understanding their relationships with their family members, as I’m a person who is interested in how

families cope with mental illness. I heard individuals with schizophrenia describe some pretty interesting delusions. I remember one man who

believed that he was the only one of the world who could impregnate women. He believed that everyone was jealous of him because of this ability.

So he was also paranoid about other people’s intentions, thinking they were out to harm him. I remember another man who wore a hat on his

head and lined it with aluminum foil because he believed that aliens were trying to change his thoughts using radio waves. The aluminum foil was

meant to keep the radio waves out of his head. I remember another man who I saw in therapy who believed that his thoughts were broadcast to

other people around him and they could hear what he was thinking. He was very concerned that they heard his negative thoughts about others,

and he felt a great deal of shame.

Thought disorder. Individuals with schizophrenia may have difficulties thinking, and their communications may be severely disorganized. At its

worst we refer to this as word salad—where words are just thrown around in a random way that make it impossible for the listener to understand

what the individual is communicating. I remember times when I would interview a patient for an hour, walk out of the session, and ask myself,

“What’s wrong with me today? I just can’t seem to understand what’s going on.” What was really going on is that I had just spent an hour trying

to understand a very thought-disordered patient.

Disorganized behavior. Individuals with schizophrenia may behave in ways that appear bizarre to many of us. They may put objects in odd

places and engage in repetitive nonsensical behavior. I remember a mentally ill man on the street who had fashioned a very bizarre-looking hat

out of a trash can top and was walking along attracting quite a bit of attention from passersby.

The positive symptoms of schizophrenia are also what we refer to as psychosis. Psychosis does not only occur among individuals with schizophrenia

but can be evident in a number of other disorders. So if someone shows up in the emergency room with these positive symptoms, an ER psychiatrist

may have a number of questions. First, is the person using drugs that result in these symptoms? By doing a toxicology screen (from blood and/or

urine), the physician can determine if drugs might be the cause. An individual who has been using a lot of amphetamines or cocaine, among other

drugs, may show many of the positive symptoms of schizophrenia. Second, the person may be having psychotic symptoms as a result of bipolar

disorder or severe depression, and we will talk about these a bit later. By conducting an in-depth history of the psychotic and other symptoms, when

they began to show themselves, and how the problems began to emerge, a psychiatrist or ER physician may be able to determine if there is another

mental health problem that might explain these symptoms. Third, these positive symptoms could be a result of another type of neurological problem.

For example, untreated syphilis can lead to brain deterioration with symptoms that look a lot like psychosis. Diagnosis can be tricky!!

I particularly like the painting below. It was done by someone with the experience of psychosis. It uses all sorts of wonderful colors, but also notice all

the eyes. It really has a disturbing and paranoid sort of feel, doesn’t it?

Songs of Schizophrenia

xalinea

Negative Symptoms

What are negative symptoms? By negative symptoms we don’t mean bad symptoms (although, in honesty, most of these are not good for the

individual dealing with them!); what we mean is an absence of typical or normal behavior. Some examples of negative symptoms include:

Flat affect. By affect we mean emotional expression. In flat affect an individual lacks the normal range of emotional expressiveness, and

their response may appear "off." For example, an individual with flat affect may appear to have little emotional reaction when discussing

something very painful. This is not to say that they do not feel normal emotions but rather that they lack the ability to convey these in their

expressions.

Alogia. This refers to a “poverty of speech”; the individual may talk very little or talk for some time but say very little.

Avolition. Individuals with schizophrenia may have difficulty initiating and persisting in activities and show little motivation. They may sit for

hours doing very little. They may show very poor self-care, including lack of bathing and changing clothes.

In order for schizophrenia to be diagnosed the symptoms have to be present for at least six months (unless adequately treated earlier). So the very

diagnostic criteria for schizophrenia include the assumption that it is rather chronic as an illness.

I’d like you to take a look at this video and see what you notice in terms of the positive symptoms and the negative symptoms in this gentleman.

Please click on the image to go directly to the Annenberg website to view this video. Source: Annenberg Learner

What symptoms, both positive and negative, did you notice that this man exhibited?

Type your response here

SAVE RESPONSE

VIDEO FOLLOW-UP

Epidemiology of Schizophrenia

How common is schizophrenia? Large-scale epidemiologic studies suggest that approximately 1% of the world’s population meets the diagnostic criteria

for schizophrenia. So while somewhat rarer than other mental disorders, a large number of people worldwide are impacted by this disorder (over 3.2

million in the United States). It is slightly more common in men than in women. Interestingly, rates of this disorder vary somewhat between countries,

but schizophrenia is seen in all cultures. I think this speaks to some profound biological underlying causes.

What is the course of schizophrenia? Onset is when the illness first begins, and course is what happens over time to these symptoms in the life of

someone living with schizophrenia. First, schizophrenia typically tends to emerge, or has its onset, in the late teens or early adult years. It can have a

much earlier onset. In fact, as I noted above, one of the research studies that I worked on as a graduate student was to conduct follow-up interviews

of children who had been diagnosed with schizophrenia prior to age 11. This childhood onset-type of schizophrenia is exceedingly rare. It can also show

up in a person's 20's or 30's. Second, once diagnosed, schizophrenia tends to be rather chronic. The goal of treatment is to reduce psychotic

symptoms; improve the individual’s engagement in life and his/her functioning in social, occupational, and other domains; and help him/her avoid

further psychotic periods. In general, people who work to help individuals living with schizophrenia talk about the 1/3 – 1/3 – 1/3 rule—that’s the idea

that approximately one third of those diagnosed with schizophrenia will mostly recover, another one third will improve but have some chronic

symptoms, and one third tend not to recover much of their previous functioning. One observation, though, has been that many people with

schizophrenia do tend to improve as they enter the later parts of their lives. The psychotic symptoms of schizophrenia tend to “burn out.”

You might find it interesting to step yourself through this epidemiology and risk factors quiz about schizophrenia. You'll need to click on the image to go

to the site (don't worry, the answers to the questions follow each question.)

by Brian Miller, MD, PhD, MPH, Modern Medicine Network

Deinstitutionalization

Deinstitutionalization, Its Causes, Effects, Pros and Cons

One societal factor that has very profoundly influenced the lives of people living with schizophrenia is deinstitutionalization. Deinstitutionalization is

the movement to shift people from living in long-term mental hospitals to living in communities. This process began in the 1960s. The idea here was a

noble one—to provide care within communities to those living with mental illness. By establishing community mental health centers and “sheltered

workshop” employment opportunities, the government could help produce more humane living conditions for those with mental illness and reduce the

burden of cost associated with these long-term mental hospitals. Believe me, these long-term hospitals were pretty bleak and depressing places!

Unfortunately, during the Reagan administration the federal government support for these community-based programs was reduced and block grants

were made to states to administer these programs. These programs were subsequently highly underfunded, leading to a real shortage of mental health

treatment in community settings. So what’s been the result of this?

First, the largest provider of treatment in this country is the penal system. Jails and prisons provide more mental health care than any other setting.

Unfortunately, this doesn’t work so well. Individuals often go to jail (maybe due to bizarre behavior in public, trespassing due to homelessness, etc.),

are finally able to get some medication (minimal treatment) for their mental health disorders, and are then unable to continue this treatment after

getting out of jail. So this leads to inconsistent treatment for many of the most vulnerable individuals with mental illness. In addition, jail is a seriously

stressful place to spend time, and this stress can make mental health problems much worse. Second, there are few resources in communities to assist

people with mental health problems to get adequate treatment. The states were unable to provide adequate resources through block grants and those

grants ended. Even people who are very interested in seeking treatment cannot always get it. Opportunities for job training are really limited as well.

Third, there has been an increase in the number of homeless mentally ill individuals living on our streets in America. If you go to places like New York

City’s Port Authority Bus Terminal, or to our own South Station you will see many homeless individuals who are suffering from mental health disorders,

schizophrenia chief among them, who are begging on the streets. I’d like to think that as a society we could do better for some of our most vulnerable

citizens!

Factors Contributing to Schizophrenia

What might be the causes of schizophrenia? Well, it’s not generally helpful to talk about the “cause” because it’s likely that many things contribute to

the development and maintenance of schizophrenia. I’d rather focus on “contributing factors.” Let’s go through some of these.

Vulnerability-Stress Disorders

Schizophrenia is one of a number of disorders that we refer to as vulnerability-stress disorders. In a vulnerability-stress disorder, an individual has

a “vulnerability” that is likely biological in nature. As an example of another type of medical condition that is a vulnerability-stress disorder, think about

heart disease. Individuals with heart disease have a vulnerability to acquire plaque in their arteries, and this plaque restricts blood flow and increases

pressure on the heart’s pumping capacity. This vulnerability to form plaque may be genetic. However, even if you have a vulnerability, you may not

show the disorder unless you are exposed to certain types of stress. Stress that contributes to heart disease includes smoking, ingestion of high

cholesterol foods, physical inactivity, and overeating. Vulnerability + Stress = disorder (heart disease). One of the ways that we treat vulnerability-

stress disorders is to use medication to treat the vulnerability, and psychological interventions (therapy) to improve the stress piece. In heart disease,

doctors may prescribe statin medications to reduce cholesterol (vulnerability) and dietary changes and exercise to reduce biological stress.

Source: Pachani, N. (2015). Stronger connections: Family stress, violence, and mental health. International Journal on Women Empowerment, 1, 45–47. DOI: 10.29052/2413-4252.v1.i1.2015.45-47.

So, what might be some of the contributing vulnerability and stress factors in schizophrenia?

Genetics A number of methods have been developed over the years to study the role of genetics in mental health (and other) disorders. I will first describe how

we do these studies and then tell you about the results for schizophrenia.

One way to study genetics and mental health disorders is to see whether it runs in families—family history studies. Compared to individuals

without schizophrenia, do individuals who are diagnosed with schizophrenia have more family members diagnosed with schizophrenia? The answer

seems to be yes. However, just because something runs in families doesn’t mean it’s genetic. Families also transmit ways of coping, traditions,

health habits, and many other things.

A second way to study genetics and mental health disorders is to look at adoption studies. For example, if an individual’s biological mother has

schizophrenia but that individual is raised by an adoptive family without a history of schizophrenia, will that individual still be at higher risk for the

development of schizophrenia? In general the answer seems to be a qualified yes.

A third way to study genetics and mental health disorders is to use twin studies. There are two types of twins. Monozygotic twins, also known as

identical twins, form when the initial fertilized egg splits into two, forming two perfectly identical individuals. Monozygotic twins share 100% of

their genes; they are always the same biological sex. Dizygotic twins, also known as fraternal twins, form from two different sets of eggs and

sperm that happened to be fertilized at the same time and share the womb. Dizygotic twins share about 50% of their genes; they can be the

same sex or opposite sexes. Indeed, dizygotic twins share no more genetic material than do regular siblings. So, if a trait (like a mental illness) is

genetically determined, monozygotic twins should be more likely to share this trait than should dizygotic twins. We call this concordance—when

one twin has it and the other one does as well. The concordance rate is the percentage of twin pairs that shares the trait. In schizophrenia, if one

sibling in a monozygotic twin pair has schizophrenia, the likelihood the other one has it is about 46% (that’s the concordance rate). However, if

one sibling in a dizygotic twin pair has schizophrenia, the likelihood the other will have it is about 14%. This is strong evidence that genetics

contribute to the vulnerability to schizophrenia. On the other hand, it also clearly illustrates that schizophrenia is not 100% genetically

determined. If that was the case, then the concordance rate for monozygotic twins would be 100%! It is far from 100%, at only 46%.

So we know that genetics may play a role but it certainly isn’t the only factor involved.

Abnormal Brain Chemistry One of the leading theories about the causes of schizophrenia is known as the dopamine

hypothesis. This hypothesis is that excesses in the activity of the neurotransmitter

dopamine in the brain may be responsible for many of the symptoms of schizophrenia. What

is the evidence for this hypothesis? First, drugs that increase dopamine activity in the brain,

including cocaine and amphetamines, can produce the symptoms that we see in

schizophrenia. Second, antipsychotic drugs that are used to reduce the symptoms of

schizophrenia are typically ones that reduce or block dopamine in the brain. However, several

of the new drugs used to treat schizophrenia do not directly affect dopamine, calling into

question some of the assumptions of the dopamine hypothesis. There are so many

neurotransmitter systems in the brain that work together, and indeed, there are many

subtypes of the dopamine receptor! Understanding the neurochemistry of schizophrenia is a

big job.

Environmental Factors There is certainly evidence that early environmental factors may shape the vulnerability to schizophrenia. Here are two that might be really important:

Problems during delivery of the baby may increase risk of schizophrenia. One birth complication is the

use of forceps. Forceps were used to grip the baby’s head and help slide him or her from the birth canal.

A forceps delivery could leave bruises on the child’s head. Remember that in this period of development,

the skull is very soft and the brain very vulnerable. Forceps delivery may have led to lasting and s