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Lecture 14

Detailed Lecture 14 Notes - Psychological Disorders

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Department
Psychology
Course
PSY100Y5
Professor
Ayesha Khan
Semester
Winter

Description
Chapter 14 – Lecture Part 1 Psychological Disorders  How do we figure out he or she is showing abnormality behavior? What is abnormal behavior?  Social standards are often the first thing people to asses what is normal or not  Religion can be a way how people assess if a behavior is right or not  Social conception of what is right and wrong (social aspect)  Medically  diagnostic The Elements of Abnormality  Elements of abnormality include:  Suffering o If a person suffers psychologically, we inclined to consider that is this abnormality  Maladaptiveness o If you have someone who is experiencing anorexia, where she or he starves themselves to the point where they go to the hospital o We can say its abnormal behavior because its maladaptivess because it is not going to help her survive  Deviancy o Its statistically rare o Where you hardly don’t see it in the population  Violation of the standards of society o Violation that we have collectively to be outside of the norm o Often time the classification of abnormality may change depending on the era o Ie. Homosexuality was said to be abnormal behavior in certain areas o We constantly re-evaluate what we consider to be the norm  Social discomfort o Is it socially discomforting to those around the individual? o How are other people reacting to this individual?  Irrationality and unpredictability o Person randomly get up and screams and leaves the room Diagnostic and Statistical Manual of Mental Disorders (DSM)****  Published by the American Psychiatric Association ** o Changes every couple of years because rules of societies changes over time o Currently in its 4 edition o DSM-IV- TR  means it was further revised  Covers all mental health disorders for both children and adults o Once it was considered that children don’t have mental disorders o With the revisions that started to take place, the addition of children become important for diagnosis  Statistics in terms of  Gender o Disorder in women or men?  Age at onset o When does it start to arrive?  Prognosis o What is the outcome of this treatment? o Good or bad?  Some research concerning the optimal treatment approaches o What might work better for depression vs. anxiety The DMN-IV Definition of Mental Disorder***  A clinically significant behavioral or psychological syndrome or pattern o If it is clinically significant, it meant that a psychologist has to diagnose it o Psychologists to classify it  Associated with distress or disability (i.e., impairment in one or more important areas of functioning) o It associated with distress or disability, that’s causing the ability to do well in school, work, relationships  Not merely an expectable and culturally sanctioned response to a particular event (e.g., the death of a loved one) o Cultural expectation becomes very important o This is not abnormal behavior if your sad because of the death of a loved one  Considered to reflect behavioural, psychological, or biological dysfunction in the individual o Something not right o Use elements of abnormality to see if there is a dysfunction in the individual DSM-IV Multi-Axial Diagnosis  Axis I: All mental disorders (except) o Clinical syndromes o Mental health related disorders o Example: depression  Axis II: Personality disorders & mental retardation o Anti-social personality disorder  disregarding the rules and the rights of others o Development disorder appears during childhood ie. Autism  Axis III: Physical disorders o HIV status, AIDS, cancer, diabetes o Classify by a provided description from a psychologists  Axis IV: Psychosocial and environmental problems o Having a lot of stress in a relationship (ie. With a boss, friend, partner) o Psychologist will evaluate o Assessment in an overall environment  Axis V: Global assessment of functioning scale o Takes into a lot of the variables in the other axis’s and puts them together globally o How is this person doing today and the past year? Anxiety Disorders  Anxiety vs. Fear  Anxiety – overall feeling of uneasiness The DSM-IV Anxiety Disorders 1. Generalized Anxiety Disorder (GAD) 2. Panic Disorder with/without Agoraphobia 3. Specific Phobia 4. Social Phobia 5. Obsessive Compulsive Disorder (OCD) 6. Post Traumatic Stress Disorder (PTSD) Generalized Anxiety Disorder  General anxiety about a lot of factors in their life  Chronic & high level of anxiety not tied to a specific threat (free-floating) o Cannot pin-point the source just feeling of uneasiness o It is chronic  ongoing and doesn’t go away  Worry about minor matters (e.g., family, school, work, friends etc.) o Tends to attach itself to a variety of situation (again free-floating)  Seen more frequently in females than in males Generalized Anxiety Disorder: Biological Factors  It is modestly heritable o Neither here or there modest o Cannot say with a lot of certainty that generalized anxiety is all genetics or all environment o Can’t say its all genes  The neurotransmitters GABA, serotonin, and perhaps norepinephrine all play a roll in anxiety  Corticotropin-releasing hormone (CRH) also plays a role o Central nervous system  limbic system (for emotionality)  hypothalamus releases hormones and has a direct effect to the pituitary gland (because it sits on top of it) Hormones relesed: o CRH: secreted from the Hypothalamus o ACTH: secreted from the Pituitary and happens during times of stress and goes to the periphery and to the adrenal gland o Stress hormone (cortisol): adrenal gland (sits on top of the kidneys)  Neurobiological factors implicated in panic disorders and GAD are not the same o Neurobiological factors are different in other kinds of anxiety disorders o Different regions of the brains are implicated during different anxiety disorders Panic Disorder  Recurrent, unexpected panic attacks o Element of surprise to it  AND one month of concern about additional attacks o Element of memory of previous memory attack  OR... worry about the implications of the attack or its consequences  OR... a significant change in behavior related to the attacks Panic and the Brain  Where does the anticipatory anxiety occur?  The anticipatory anxiety about future panic attacks is thought to arise from activity in the limbic system o Emotionality arises from the set of structures called the limbic system  Phobic avoidance may involve activity of the hippocampus o Start to avoid certain situations that might lead to a panic attack o Part of it has to do with memory of what happened during your last panic attack o Example: if the last panic attack happened during of an exam, you might avoid going to school o Hippocampus is associated with memory  Panic attacks may arise from abnormal activity in the amygdala  Locus Coeruleus o Brain stem structure o Leads to panic attacks when there is a stimulus o Stimulating the Locus Coeruleus, stimulates the amygdala Criteria for a Panic Attack  ****Discrete period of intense fear/discomfort in which at least 4 symptoms develop abruptly and reach a peak within 10 minutes  Palpitations, pounding/racing heart  Sweating  Trembling/shaking  Shortness of breath/smothering sensations  Feeling of choking  Chest pain/discomfort  Nausea or abdominal distress  Feeling dizzy, unsteady, faint or lightheaded  Derealization or depersonalization  Fear of losing control or going crazy  Fear of dying  Paresthesias (numbness or tingling sensations)  Chills or hot flushes Agoraphobia  Anxiety about being in places/situations from which escape might be difficult or embarrassing in the event of a panic attack  Situations are avoided or endured with marked distress or anxiety about having a panic attack OR require the presence of a companion Typical Agoraphobic Situation  Shopping malls  Cars  Trains  Buses  Subways  Wide streets  Tunnels  Restaurants  Theatres  Supermarkets  Stores  Crowds  Planes  Elevators  Escalators  Waiting in line  Being far from home “out of safe zone” o Anywhere it can happen Specific Phobia  Marked and persistent fear that is excessive or unreasonable, cued by a specific object or situation  Exposure to the phobic stimulus almost invariably provokes an immediate anxiety response (e.g., a panic attack)  Phobic situation/object is avoided or endured with intense anxiety and distress Specific Phobia – Types 1. Animal 2. Natural Environment (e.g., heights, water) 3. Blood-Injection-Injury Type 4. Situational (e.g., planes, elevators, driving) 5. Other (e.g., choking, vomiting) Social Phobia  Marked and persistent fear of social or performance situations  Situations involve exposure to unfamiliar people or to possible evaluation by others  Individual fears that he/she may do something humiliating or embarrassing. Obsessive-Compulsive Disorder  Recurrent and persistent obsessions and/or compulsions  Symptoms cause marked distress  Time consuming (more than 1 hour/day)  Interfere significantly with person’s normal routine Obsessions  Persistent and intrusive thoughts, impulses, images  Inappropriate, cause marked anxiety or distress  Person usually attempts to ignore or suppress them  ...OR neutralize them with some other thought or action Compulsions  Repetitive behaviours or mental acts  Performed to prevent or reduce anxiety/distress, not to provide pleasure or gratification Obsessive-Compulsive Disorder  Obsessions consist most often of o Contamination fears o Fears of harming oneself or others o Lack of symmetry o Pathological doubt  Compulsions include o Cleaning o Checking o Repeating o Ordering/arranging o Counting Post-Traumatic Stress Disorder: Reactions to Catastrophic Events  Happens after a traumatic event  IE. Veteran soldiers  ***Results from exposure to events that have the potential to cause death or serious injury such as: o Combat o Sexual and/or physical assault o Natural disaster o Diagnosis of a serious illness  These severe symptoms can include o Persistently re-experiencing the traumatic event o Persistently avoiding stimuli associated with the trauma o Chronic tension, irritability, and insomnia o Impaired concentration and memory o Feelings of depression Prevalence of PTSD in the General Population  Although two-thirds of North American adults will experience a traumatic event, only 9.5% will develop PTSD.  PTSD is twice a
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