Abnormal-Psychology (thesis)

Abnormal Psychology

Introduction

The Diagnostic and Statistical Manual of Mental Disorders is used by psychiatrists, as well as psychologists, although since they are not doctors, psychologists cannot diagnose a patient or prescribe medication. Psychology professionals’ treatment usually consists of cognitive behavioral (“talk” and restructuring) therapy.

The DSM-IV-TR is divided into five axes. Axis I states any mental disease, Axis II is for personality disorders and mental retardation, axis III is for general health, axis IV refers to psychosocial and environmental factors, and Axis V is for functioning (on a scale). Since its inception in 1952, the manual has changed many times and now includes substance abuse and eating disorders. All disorders have as a condition that they must cause significant distress to the patient and/or impair his or her functioning in some significant way.

Also, the disorder should not correspond to the expectations of the individual’s culture (e.g. if a person is part of a tribe that ritualistically believes going into trances and seeing mountains dance, a person from that tribe cannot be considered delusional if he or she complies with the norm; this may be a little exaggerated but hopefully it gets the point across). The following information is IN NO WAY SUFFICIENT to allow a diagnosis.

AXIS I

Schizophrenia Schizophrenia literally means a splitting of the mind, which is a fairly accurate description since the clinical disorder is a sort of split from reality. There are several types of Schizophrenia: Paranoid, Catatonic, Residual, Disorganized (Hebephrenic) and Undifferentiated. Symptoms can be positive - aspects that are there but that should not be, and negative - aspects that should be present but are not.

The main positive symptoms include delusions (irrational persistent beliefs in spite of evidence to the contrary) and hallucinations (perception in the absence of stimuli). Negative symptoms include flat affect (inability to express emotions), lack of personal hygiene, social and occupational dysfunction. There currently is no cure for Schizophrenia but antipsychotics and other drugs can help control the problems.

Depression & Bipolar Disorder

In Major Depressive Disorder (MDD) some of the recurrent signs are low and sad mood that lasts for over two weeks, loss of concentration, feelings of despair or helplessness, changes in weight and/or appetite, social withdrawal, loss of interest in activities previously enjoyed, lack of energy, and dark thoughts. The causes of MDD are often biological and even genetic (people who are homozygous - have two copies - of the short allele of gene 5-HTT are more vulnerable to develop the sickness even given the same stressors as heterozygotes).

The biological explanations stem from the findings that individuals with MDD have a lower production of the neurotransmitter serotonin (feelings of well-being regulator). Consequently, serotonin reuptake inhibitors such as Prozac have been successful, however antidepressants have also backfired in several, sometimes tragic, ways. Depression is almost twice as common in women than in men. Individuals suffering from manic depression (Bipolar Disorder) alternate between days of mania and months of depression. During manic episodes, individuals tend to become promiscuous, reckless, very talkative, elated and prone to overspending. The mood stabilizer lithium is often used to treat this condition.

Phobias may vary. Illustration by Elena.

Phobias OCD, GAD, AD(H)D

A writer with Obsessive-Compulsive Disorder (OCD) was portrayed by Jack Nicholson in the motion picture As Good as it Gets. The disorder is characterized by intrusive thoughts, repetitive rituals and unusual behavioral patterns. Phobias are irrational fears that endure despite the patient knowing that they are irrational. Examples include fear of spiders, Arachnophobia, and of public places, Agoraphobia. Agoraphobia can manifest with or without panic attacks. People with Generalized Anxiety Disorder (GAD) tend to worry exceedingly about potential difficulties, in addition to, everyday matters. The primary distinction between fear and anxiety, is that fear is of something confirmed while anxiety is not. GAD is often treated with anxiolitics as well as antidepressants. ADD (Attention Deficit Disorder) and ADHD (Attention Deficit Hyperactivity Disorder) are mainly found in children and adolescents.

The drug Ritalin has usually been prescribed, and has also been abused by students wishing to increase their intellectual performance, a dubious and dangerous practice. A lot of discussion was generated as to whether the disorder is or not over diagnosed.

AXIS II

Personality Disorders One of the reasons that personality disorders get their own axis is that there is no cure and that they are not diseases as the previous cases. They are considered to be, in a way, the extremes of the bell curve of personalities in the general population. The fact does not make them any easier for the incumbent or those around him or her. The most vicious is Antisocial Personality Disorder, also called psychopathy. The rest are Paranoid, Histrionic, Borderline, Obsessive-Compulsive, Anxious (Avoidant), Dependent, Passive-Aggressive, Schizoid, Narcissistic, Mixed and Unspecified Personality Disorders (PDs). Persons with Borderline PD tend to hurt themselves, psychopaths others. Narcissistic and Histrionic PDs are characterized by self-centeredness for the former and excessive need to be the center of attention for the latter; Schizoid PDs comprise the attributes of solitude and emotional withdrawal (to an excess).

Mental Retardation

Mental retardation is usually diagnosed before the age of 18, by severe learning disabilities and an IQ score below 70 points on a standardized test. The condition has many genetic, biological, traumatic and environmental causes. Autism and other developmental disorders would also be coded on Axis II, even in children of normal or high intelligence.

Conclusion

In an attempt to remain concise, the above list is incomplete. Categories such as NOS (Not Otherwise Specified), and descriptive parameters (comorbidity, prevalence, incidence, demographics) were omitted. Likewise, some disorders, such as Schizoaffective, Dysthymic, Conduct and Learning Disorders, have been left out. Moreover, an alternate diagnostic tool, the ICD-10 (International Classification of Diseases, tenth version, published in 1990; in use until eleventh edition is endorsed in 2014) is beyond the scope of the present discussion.

Nothing can stop the man with the right mental attitude from achieving his goal; nothing on earth can help the man with the wrong mental attitude (Thomas Jefferson). Illustration : Megan Jorgensen.

Adrenaline and Cortisol

Adrenaline & Cortisol

The words adrenaline and epinephrine, as well as noradrenaline and norepinephrine are used interchangeably. Adrenaline reportedly has effects of giving people superhuman strength, speed and other abilities that allow them to react adequately under traumatic conditions. Underneath it all, it is adrenergic receptor activity that is sought after by adepts of extreme sports, bungee jumping and free styling.

Seifert et al. (2009) confirmed their hypothesis on cerebral metabolism, that at the brain level sugar is processed quicker due to adrenaline but not noradrenaline. Mitchell et al. (2009) examine noradrenaline spillover in the brain, and in their experiment trimethaphan injection acts as a lowering mechanism.

Cortisol is a neurohormone produced by the endocrine system. The exact fields that investigate such cases are neuropsychopharmacology and neuropsychoendocrinology. Cortisol and the HPA axis (hypothalamic-pituitary-adrenal; also known as HTPA or LHPA where L - limbic) are related to stress. Cortisol has been studied in rats; rat pups were said to grow up with different abilities for cortisol secretion depending on the way they were reared (low licking and grooming versus high licking and grooming). The finding had epigenetic implications (Lord, 2009). Epigenetics refers to the possibility that the genetic code can be altered due to environmental pressures. In the popular media cortisol and stress have been blamed for weight gain. Cortisol acts by blocking an appetite-suppressing signaller, thus leading to higher calorie consumption and fat accumulation. Stress has been cited as responsible for many ills; it is plausible that worries predispose one to overeating. In contradistinction, oxytocin is a neuropeptidede that in humans and voles is partly responsible for socialization and couple formation, and occasionally lowers cortisol released during partners’ disputes (Ditzen, 2009).

Epinephrine is sometimes confused with ephedrine or ephedra (herb). Ephedrine is a component of some gym performance enhancers, commonly called ‘fat burners’. The substance had some trouble with the FDA (Food and Drug Administration) due to suspected safety concerns, leading to regulations. But that is not the topic here. Epinephrine and norepinephrine are neurotransmitters in the human central nervous system (CNS). Both are catecholamines synthesised from the amino acid tyrosine, acting both as neurotransmitters and stress hormones.

Septic shock, a condition characterized by generalized infection and the organism’s reactions to it, is regularly treated with administration of dopamine or norepinephrine rather than epinephrine. However there is no evidence that epinephrine alone rather than norepinephrine and dobutamine does the deed any differently (Agrawal, 2010). Vasopressin is also sometimes administered in such cases, but Russell et al. (2008) consider it largely ineffective as compared to norepinephrine. The all-or-none potential of neural cells or the body’s reactions to epinephrine (adrenaline), norepinephrine (noradrenaline), cortisol, oxytocin, vasopressin, progesterone, estrogen, testosterone, dobutamine (synthetic drug), dopamine, serotonin and GABA represent typical topics of neuroscientific inquiry.

The adrenaline of a live performance is unlike anything in film or theater. I can see why it's so addictive. Gwyneth Paltrow. Photo : © Megan Jorgensen.

Interpersonal Psychology

Interpersonal Psychology

The psychology of interpersonal relations and human interaction is important to normal day-to-day functioning. Even a simple task such as buying milk at the corner depanneur (convenience store in Canadian French) would be impossible without a rudimentary understanding of the intricacies of social behaviour.

Humans are often said to be social animals. Indeed, not all animals are social, even though they are equal. Tigers and koalas are mostly solitary, while lions and chimpanzees live in groups. In the animal kingdom, and as is hypothesised for our prehistoric ancestors, such gatherings help survival by resource multiplication, protection and signalling.

Just as animals, human beings are dependent on caregivers in infancy. What comes as a surprise is the sad study that was carried out in Romanian orphanages. Due to several circumstances, at that point in time, Romanian orphanages were overcrowded and some infants failed to get the human contact required for them to develop normally. These babies were fed, bathed and kept warm, but there was little to no human presence involved. The consequences were that some failed to survive, while others grew up with strongly affected personalities (Chisholm et al., 2009).

Relationships permeate human existence. Many holidays are dedicated to social associations (Mother’s Day, Father’s day, Valentine’s Day). The Beatles sang “…all you need is love…” and scientists are consistently finding that the first and most famous boy band were indeed correct.

Research has demonstrated that social support can have not only beneficial psychological outcomes such as lifted mood, perspective taking, comfort, feelings of closeness and intimacy, but also direct physical health effects (Uchino et al., 1996). A study found that the larger the number of friends and acquaintances a person had, the less likely they were to suffer from the flu. The experimenters theorised that social support boosted the immune system. The conclusion seems possible, since although someone who is in contact with more people has a greater statistical chance to get infected, stress and guilt have been linked to flu-like symptoms. Further, they say laughter is the best medicine, it may well be that the good humours provided by pleasant friendly encounters have the opposite effect.

Social psychologists tend to explain attractiveness in terms of likeness, reciprocity and proximity. A study done in college dorms (Priest & Sawyer, 1967) showed that persons (all of whom were complete strangers prior to the beginning of the school term) were more likely to become friends with those who lived directly across the hall than with those who lived two doors down. The scientific truth is paralleled in the TV series Friends, if not in the plot then at least in the physical set up, where sister, brother and the entire circle, live close by.

According to literature accounts, friendships tend to form between those similar in intelligence, views, hobbies, education, family values and age. Of course, exceptions abound.

References:

Chisholm, K., Carter, M. C., Ames, E. W. & Morison, S. J. (1995). Attachment security and indiscriminately friendly behavior in children adopted from Romanian orphanages. Development and Psychopathology, 7 (2): 283-294.

Uchino, B. N., Cacioppo, J. T. & Kiecolt-Glaser, J. K. (1996). The relationship between social support and physiological processes: A review with emphasis on underlying mechanisms and implications for health. Psychological Bulletin, 119 (3): 488-531.

Priest, R. F. & Sawyer, J. (1967). Proximity and peership: Bases of balance in interpersonal attraction. The American Journal of Sociology, 72 (6): 633-649.

Interpersonal Psychology. Illustration by Elena.

Delusions

Delusions

Delusions are persistent irrational beliefs, immune to contrary evidence and causing great distress and/or social, professional, academic, and personal dysfunction.

While hallucinations and delusions are most commonly associated with schizophrenia, psychotic features can be present in Bipolar Disorder, severe Depression, Delusional Disorder, Dementia, Substance-Induced Psychosis and other psychiatric conditions.

Further, a person may present with schizotypy without having schizophrenia, such as in Schizoaffective Disorder or Schizoid Personality Disorder. According to Peters et al. (1999), psychotic symptoms could be viewed as the maladaptive extremes of a continuum of traits present in the general population and quantified in order to prevent breakdowns and improve treatment.

The diathesis-stress model can be defined as such: An individual has a, presumably inherited, predisposition towards an illness, but the problems will only manifest themselves if the organism experiences a significant stressor. The main themes delusions center on are grandeur, persecution (paranoid thinking), disintegration and contrition, as defined by the Delusions-Symptoms-States-Inventory (DSSI, Foulds & Bedford; 1975).

The authors found that the majority (93.3%) of their sample (480 clinical patients in psychiatry) had symptoms in agreement with the scale. The Present State Examination (Wing et al., 1974) adds three other categories, while the DSM-IV-TR (American Psychiatric Association) expands to include erotomanic, jealous, somatic and mixed subtypes in addition to the initial four. Bowins & Shugar (1998) found that a person’s self-esteem and self-regard greatly influenced the content of his or her delusional ideation, and led to “delusions [being] experienced as comfortable (or uncomfortable) and enhancing (or diminishing)” (154).

Delusions are persistent irrational beliefs. Illustration by Elena.

The following list represents the delusions’ subdivisions found in their study, in order of frequency:

I. delusions of reference

II. delusions of persecution

III. grandiose delusions

IV. delusions of control

V. thought insertion

VI. thought broadcasting (feeling that others can hear one’s thoughts)

VII. somatic delusions (hypochondriac)

VIII. delusions of guilt

IX. thought withdrawal

X. thought reading

XI. religious delusions

XII. delusions of jealousy

XIII. delusions of catastrophe

XIV. delusions of thought control

XV. sexual delusions

The scientific literature is divided on the function that delusions serve in relation to self-esteem, if any, but these experimenters were able to demonstrate that among current active psychosis inpatients, self-esteem and self regard were positively correlated with delusional substance.

Thus, subjects with better global self-images had delusions that reflected that notion more than their lower self-appraised counterparts. Bowins & Shugar (1998) also noticed that the higher self-esteem patients rated their deluded experiences more enhancing and comforting. However, the subsets of the personality variable reflecting professional, academic, physical and social dimensions failed to be translated into delusional content.

Perhaps the above information helps to understand why patients with delusions cling to their unsupported worldviews so strongly, despite the impairment it causes in their lives, especially in cases where the irrational thoughts are enacted. Even if the inner consistency rationale elucidates the disturbances, it lacks the ability to make it any easier for those afflicted as well as for their close ones. Hopefully, scientific breakthroughs will alleviate those burdens in the near foreseeable future.

“It is amazing how complete is the delusion that beauty is goodness.” (Leo Tolstoy, The Kreutzer Sonata). Image: Megan Jorgensen.

Demonology

Now, some people are not religious, agnostic or even atheist - and I believe that's ok. I believe in God, but I also believe in democracy and freedom of choice. But lately… I'm starting to understand that there are also demons! They look just like humans, but they are real demons underneath. You can usually tell, by the way their treat their own mothers, for example…

Demonology is a pseudoscience akin to astrology. Remember astrophysics and astronomy? We'll, it's nothing like that! Luckily, there are also angels, and archangels; and they fight fire with fire. Everyday. For man(and woman)kind ;)

References:

• Bowins, B. & Shugar, G. (1998). Delusions and self-esteem. Canadian Journal of Psychiatry, 43 (March): 154-8.
• Foulds, G. A. & Bedford, A. (1975). A hierarchy of classes of personal illness. Psychological Medicine, 5 (2): 181-92.
• Peters, E., Joseph, S. A. & Garety, P. A. (1999). Measurement of delusional ideation in the normal population: Introducing the PDI (Peters et al. Delusions Inventory). Schizophrenia Bulletin, 25 (3): 553-76.
• Wing, J. K., Cooper, J. E. & Sartorius, N. (1974). Measurement and classification of psychiatric symptoms. Cambridge, England: Cambridge University Press.

Serotonin

Serotonin

Serotonin (5-hydroxytryptamine) is a neurotransmitter that is primarily involved in mood regulation. The neuromodulator is best known for its involvement in depression, although its malfunction has also been implicated in other psychiatric conditions, such as Generalized Anxiety Disorder, Obsessive-Compulsive Disorder, Attention-Deficit Hyperactivity Disorder, Borderline Personality Disorder, Post-Partum Blues, Autism, eating disorders, panic attacks, phobias and even Schizophrenia (an affliction also involving dopamine overabundance).

Patients with Major Depressive Disorder produce less serotonin as measured by neuroimaging techniques, and this finding is the basis for the common medications used to treat depression, selective serotonin reuptake inhibitors (SSRI). Perhaps the most famous SSRI is fluoxetine, brand name Prozac. The production of serotonin may depend on whether the individual is homozygous (two copies) or heterozygous (one copy) of the 5-HT short allele, homozygotes are more likely to succumb to depression even if under the same stressful circumstances than heterozygotes or those who have not inherited that allele at all (Caspi et al., 2003). Individuals with two copies of the long 5-HT allele are the least prone to developing the illness. Notwithstanding, in their meta-analysis across studies, Risch et al. (2009) found little evidence supporting this result.

According to Nugent et al. (2008), severe tryptophan depletion leads to a relapse of depressive symptoms. Tryptophan is an essential amino acid found in aliments such as pasta and turkey and a precursor to serotonin synthesis. In the experiment, subjects returned to normal as soon as tryptophan was reincorporated into their diet.

In their review of findings, Russo et al. (2009) cite several authors that have attested to serotonin mediating sleep, aggression, anxiety, thermoregulation, satiety and stress, Curiously, neurogenesis also seems to depend on serotonin. The reviewers also explain the brain reaction to low tryptophan blood plasma levels and “speculate about the possible survival value of this mechanism” (259).

Neurogenesis is the appearance of new brain cells (neurons) and Banasr et al. (2004) found that adult neurogenesis is enhanced by serotonin agonists (agonists stimulate, antagonists inhibit). Several receptor subtypes are implicated in the process, and the scientists came to the conclusion that serotonin was beneficial to adult cell proliferation, especially in the following brain regions: subgranular layer (SGL), subventricular zone (SVZ), dentate gyrus (DG) and olfactory bulb. A small reminder that gyrus (plural form gyri) refers to convex parts of the brain surface gray matter, while sulci (singular form sulcus) denote concave parts.

Dayan et al. (2008) suggest that serotonin deficiency mitigates impulse control by lowering inhibition, thus making the action with potentially adverse consequences more likely. The authors also discuss serotonergic pathways’ implication in thought processes related to aversive thought processes. Recalling that in encountering a new stimulus, an organism is often faced with an internal aversion versus approach conflict, the decision resting on whether the object in question poses a threat or promises a reward, respectively.

“Most people are about as happy as their self confidence will allow them to be.” (Shannon L. Alder). Illustration : Megan Jorgensen.

References:

• Banasr, M., Hery, M., Printemps, R. & Daszuta, A. (2004). Neuropsychopharmacology, 29 (3): 450-60.
• Caspi, A., Sugden, K., Moffitt, T. E., Taylor, A., Craig, I. W., Harrington, HL., McClay, J., Mill, J., Martin, J., Braithwaite, A. & Poulton, R. (2003). Influence of life stress on depression: Moderation by a polymorphism in the 5-HTT gene. Science, 301 (5631): 386-9.
• Dayan, P.  & Huys, Q. J. M. (2008). Serotonin, inhibition and negative mood. PLoS Computational Biology, 4 (2): 0001-11.
• Nugent, A. C, Neumeister, A., Goldman, D., Herscovitch, P., Charney, D. S. & Drevets, W. C. (2008). Serotonin transporter genotype and depressive phenotype determination by discriminant analysis of glucose metabolism under acute tryptophan depletion. Neuroimage, 43(4): 764–774
• Risch, N., Herrell, R., Lehner, T., Liang, K. -Y., Eaves, L., Hoh, J., Griem, A., Kovacs, M., Ott, J. & Merikangas, K. R. (2009). Interaction between the serotonin transporter gene (5-HTTLPR), stressful life events and risk of depression: A meta-analysis. JAMA, 301(23): 2462–2471.
• Russo, S., Kema, I. P., Bosker, F., Haavik, J. & Korf, J. (2009). Tryptophan as an evolutionary conserved signal to brain serotonin: Molecular evidence and psychiatric implications. The World Journal of Biological Psychiatry, 10: 258-68.