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Psychopathology Lecture Notes from February 4th and 7th

14 Pages

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Mary Theresa Howard

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February 4 , 2014 Video: Lost in the Mirror- D.I.D • 80% of doctors believe this disease is real • Rare • Three faces of Eve: Eve White, Eve Black, and Jane • Over a period of 44 years she had 22 personalities • Attacks could be painful. Severe headache, then a dark period which lead into a change in personality • The amount of time you stay in these alternate personalities varies • Some personalities don’t know other alters exist or what they do when they are present • Ages differ with personalities. These personalities develop at certain ages for certain reasons and the age that personality develops is the age that alter remain throughout their whole life • With Eve personalities were at competition with each other • There is a obvious change inside the brain when scanned with each alter • Different alters can have different problems i.e. being blind or deaf that don’t come out with the other alters • One personality given a tranquilizer is put to sleep but can change into another alter that isn’t effected • Alternate identities are seen as fragments of one personality • Come time protective dissociative identity doesn’t get change back due to trauma • These people are punished for things and happen to change back during and are then confused why they are being punished because they don’t remember doing anything • Authentic multiple personalities are possible. Doctors get over excited and they produce more personalities by encouraging or assuming a new personality has come out which then makes the patient want to make the doctor happy so it develops • Found that it can be cured by focusing on functioning on who they truly are, the core personality rather than bringing out the different personalities • Some alters actually said good bye after this treatment • Lucy is still dealing with personalities • Majority of people diagnosed with this disease are women • Losing time • Psychiatrists say child alters represent separate painful memories • Possible biological susceptibility Dissociative and Somatoform Disorders • Up to DSM IV: four disorders for dissociatice • The DSM V takes a few away or combines them. Diffential Dissociative disorder, differential amnesia combined with fugue and depersonalization Dissociative Disorders History • Characterized by severe disturbances or alterations of identity, memory and consciousness • Dissociation is the defining symptom • Little empirical research exists re these disorders • Believed to be quite rare but higher rates have been reported Dissociative Amnesia • Involves real and complete memory loss for extensive and important actions or impersonal information in the absence of any physical/medical causes • Five patterns of memory loss: o Localized amnesia: person fails to remember information during a specific time period o Selective amnesia: only parts of the trauma are recalled o Continuous amnesia: person forgets information from a specific date to present o Systematized amnesia: only certain categories of information are forgotten o Generalized amnesia: the person forgets their entire life Dissociative Fugue • Loss of memory, including personal history • Persons travel far from home and adopt new identities and occupations • Two important features of diagnosis are: sudden and unexpected travel away from home or work; and the inability to recall one’s past • Fugue state must be distinguished from malingering Depersonalization • Experience characterized by sense of unreality and detachment from self (derealization) • Usually appear in adolescence, tends to be chronic in nature • No impairment in memory loss, or identity confusion • Brain abnormalities in perceptual pathways have role in the process Dissociative Identity Disorder • Most severe and chronic of the dissociative disorders • Characterized by the existence of two or more unique personality states that regularly take control of the patients behavior • Each personality, or alter, may be very distinct and have different behaviors, tones of voice, age and gender • One is defined as “host” • Alters may/may not be aware of others • DID diagnosis: must be at least two alters which exert control over behavior • Transition from one alter to another is called a switching: generally results from stress or some cue in the environment • DID was believed to be quite rare but incidence has increased • Ages of these alters never change and they are different than the core personality • Tend to be very creative people • Suggestibility: can be hypnotized and can get benefit to bring alters together. Not all population is suggestible • Many can hold jobs but also many aren’t capable • During treatment it can cause many more personalities to show Etiology • Some sort of trauma severe enough usually at a young age, that they break off to protect themselves • Tends to be sexual abuse but it can be any kind of trauma • Socio-cultural model: therapist begins to believe another person has come out whether they have and the client then begins to believe it and more identities appear • Vast majority of dissociative disorders are results of intense psychological trauma • Controversy over nature and etiology of DID • Some critics suggest that it might be manufactured in therapy Treatment • Psychotherapy involves several stages 1. Establishing trust with the person in front of you whether core or alter 2. Assistance in developing new coping skills to work through their difficult history. Help them be aware of other alters and why this is happening 3. Final stage: integration of personalities using hypnosis contact alters; medication is helpful in treating comorbid disorders ex. Depression but not in the direct treatment DID Somatoform Disorders History • Occurrence of physical symptoms for which there is no known physical cause, excessive preoccupation with minor physical symptoms, or excessive concern about normal bodily functioning • People with this disorder don’t consciously produce or control the symptoms which take many forms • Two conditions in which the individuals intentionally pretend to be ill: malingering and factitious disorders: few epidemiological studies exist on the prevalence of this disorder. But disorder is diagnosed in 5 to 40 percent of patients attending mental health clinics Somatization • Characterized by multiple and recurring complaints of physical ailments with no organic basis • Patients attribute symptoms to serious medical illness and resist suggestions that psychological factors contribute to illness of disability • Patterns tend to be observed early in life, with differing symptoms across cultures • Understanding the socialization of the individual is an important feature in the diagnosis • Something they feel all the time Conversion • Person experience motor symptoms or disturbances in sensory functioning that appear to be caused by a neurological problem, but no physical cause if present • Motor deficits may include paralysis, impaired balance, inability to speak, urinary retention, or a sensation of a lump in the throat • Classical pattern has been conversion stoking or glove anesthesia (when hands and feet become numb) • Difficult to diagnose – people show lack of concern about severity of symptoms (la belle indifference) • La belle indifference: these people don’t care about what has happened or their loss. No distress • Placebos given to help • Convert trauma they have been through into a loss of that sense they used Pain Disorder • Diagnosed using the DSM-IV-TR when psychological factors are important in the onset, exacerbation, severity, or maintenance of the patient’s pain complaints or disability • Iatrogenic, or treatment-caused problems as a result of the use of pain medications are not uncommon among these patients Hypochondriasis • Excessive preoccupation with fears of having a serious illness despite assurance that fears are groundless • Diagnosed when a individual misinterprets minor bodily symptoms as evidence of a serious illness • Patients will often resist referrals to mental health professional • Usually identified in early adulthood and may be associated with an early loss of a significant person or childhood illness • This is if there is a preoccupation with the FEAR of a serious illness Body Dysmorphic Disorder • Individual is unusually and excessively preoccupied with an imagined defect • Or an exaggeration of some aspect of his or her personal appearance • Frequently feel like everyone else notices the “defect” • Preoccupation causes distress or impairs functioning Etiology • Over time moved away from psychoanalytic positions • Possibilities exist for influences in life history or the current life circumstances • Socialization and prior experiences with illness may also play a role in development of somatoform disorders Treatment • Focus on affective, cognitive and social processes that maintain excessive or inappropriate behavior • Cognitive-behavioral approaches and treatment programs that focus on social skills training, relaxation, and scheduling activities, have been used to treat patients with Somatoform disorders • CBT: help them cope with the thought of severe symptoms Chapter 7: Psychophysiological Disorders History • Idea that psychological processes can have impact on bodily states, even to the extent of producing physical disease, has a long story • Medical and psychological activities converged in psychosomatic medicine concerned with psychosomatic disorders • DSM-II introduced the term psychopysiologic disorders • Covered in a brand of psychology called: behavioral medicine or health psychology Issues • When a major element of a disorder is a diagnosable medical condition, that condition will be noted on Axis III of the DSM-IV • Indicates that there is a psychological factor affecting a medical condition Psychosocial Mechanisms of Disease • Illness= symptoms (subjective reports by the patient) • Disease= signs (objective indications that are in the textbook) • Endocrine: HPA axis highly responsive to psychosocial variable • ANS: sympathetic and parasympathetic (relaxed) • Immune system: psychoneuroimmunology finds the immune system can be affected by learning experiences, emotional states and personal characteristics Psychology of Stress • Hans Selye: general adaptation syndrome (GAS) I. Alarm (adaptation challenge) situation perceived as stressful and if the challenge persists then, II. Resistance (fighting or coping) use resources and stress still doesn’t go down and with continued challenge, III. Exhaustion (resistance fails) which lowers the immune system and organism become susceptible to disease Psychosocial Factors of Disease • Social status • Controllability: internal/external • Social support: lack of Disease and Psychosocial Factors • Infectious disease especially viruses • Ulcers: influence on development of ulcers • C.V disease: type A personality- hostility, obsessive compulsive, driven Treatment • Two classes of intervention that characterize work in this field: i. Generic approaches of management of stress related to the problem. Manage the overall problem and, ii. Interventions directed toward specific psychosocial variables thought to play a role in disease etiology February 7, 2014 Ch. 9: Schizophrenia • People who don’t understand this type of mental illness misinterpret what is going on and associate it with D.I.D History • The lifetime risk is about 1% of the whole Canadian population • Most frequent between 20 and 40 years of age • Early onset is after 1
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