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Chapter 12.docx

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Miami University
PSY 111

Insanity—a legal, not psychological, concept  Roots of the Concept of Insanity o Ancient Greeks would appoint guardians for individuals with impaired decision making o British Law in 1843: Daniel M’Naughton thought Prime Minister was going to kill him, so he planned to kill Prime Minister. Killed secretary on accident. Essentially declared not guilty by reason of insanity.  Definition of Insanity in most states: You are not guilty if at the time which you committed the crime, you couldn’t tell the difference between right and wrong (Right-wrong or M’Naughton definition)  Indiana Law judge must appoint at least 2 professionals to offer their opinion if someone attempts to plea not guilty by reason of insanity  Process for Pleading Not Guilty by reason of insanity o Burden of Proof on the defendant (unlike Hinckley case) o Standard (Level) of Proof. There are 3 in our legal system  Beyond a Reasonable Doubt (95-99%)  Clear and Convincing (75%)—used for plagiarism and civil commitment (for insanity)  Preponderance of the Evidence (51%)—used in civil cases (Nobody goes to jail: car accident damages, etc.), and for not guilty by reason of insanity o Most successful pleas of NGRI are heard by judge (not jury)  Data on the Insanity Plea o Analysis of 1 million felony indictments o Frequency of insanity pleas is less than 1%, but general public believes it to be ~35-40%. (Availability Heurisitc) o Results: 25% are successful. o Portrait of those who plead NGRI:  Male (commit most crimes)  30s  Crimes: assault and property crimes, Not murder (which people believe is most common)  Most have a previously diagnosed mental illness and prior hospitalization  Diagnosis: Schizophrenia and Bipolar Disorder Abnormal Behavior  Criteria for abnormality o Statistical Rarity—by itself, this is not a consistently useful indicator. Some rare behaviors (straight As) are desirable o Interference with normal functioning  Dysfunctional—behaviors that adversely affect an individual’s day-to-day functioning o Personal Distress—a person may have a psychological disorder if his behavior is upsetting, distracting, or confusing to himself o Deviance from Social Norms  Models of Abnormal Behavior o Medical Model—approaching abnormal behaviors as one would approach a medical illness. Believe mental disorders have underlying organic causes o Psychological Models—emphasize the importance of mental functioning, social experiences, and learning histories when trying to explain abnormal behavior  Psychodynamic Model—view that disorders result from unconscious conflicts related to sex or aggression  Behavioral Model—view that psychological disorders are learned behaviors hat follow principles of classical or operant conditioning, or modeling  Associated with John B. Watson and B.F. Skinner  Cognitive Model—view that emphasizes thinking as the key element in causing psychological disorders. Focuses on understanding the content and process of human thought. o Sociocultural Model—view that emphasizes the importance of society and culture on the frequency, diagnosis, and conception of psychological disorders.  Factors such as poverty and discrimination may promote a climate that increases the likelihood that psychological disorders will develop.  Culture-bound syndromes—tend to be limited to specific cultures Classifying Psychological Disorders  Diagnosis—the process of deciding whether a person has symptoms that meet established criteria of an existing classification system  DSthIV-TR (Diagnostic and Statistical Manual of Mental Disorders, 4 Edition, Text Revision)  Labeling Issue—A label can influence people’s perception. When filtered through a diagnostic label, normal behaviors can be perceived as abnormal  Prevalence—number or percentage of people in a population that have ever had a particular disorder during a specified time period  Incidence—number or percentage of newly diagnosed cases of a particular disorder in a given population Somatoform Disorders—bodily symptoms without physical causes  These are not psychophysiological/psychosomatic disorders (which are disorders where the emotions have effect on health. You can die of psychophysiological disorders but not somatoform disorder)  Hypochondriasis [literally, below the breast bone] o Focus on physical symptoms thought to indicate a serious illness o Difficult to treat because they do not accept that their symptoms are psychological (Doctor shop for another doctor who “takes their symptoms seriously”) o Their beliefs are genuine, they do not voluntarily produce their symptoms (Do not confuse with Munchausen)  Somatization o Numerous physical complaints involving many parts of the body.  More generalized than Hypochondriasis, whose symptoms focus in on a specific disease o More often diagnosed in females, beginning in the 20s  Conversion Disorder (hysteria) o Development of physical symptoms, usually in senses or limbs, often related to some form of conflict o In contrast to Hypochondriasis and Somatization Disorder, these symptoms are usually in limbs or motor cortex (areas that are normally under control) o Hippocrates noticed this in women and concluded that it was the uterus moving around the body because she wanted to get pregnant, and where the uterus ended up would cause a physical symptom. He prescribed sex. o Freud also believed it occurred only in women and as a result of a sexual conflict o Primary Gain—you get out of the difficult conflict o Secondary Gain—attention you receive due to physical symptom o Differential Diagnosis  La Belle indifference—individuals with conversion disorder often don’t have the emotional response you would expect  No atrophy  Selective nature of the dysfunction o Example: hysterical blindness o Case of the Naval Aviators o Modeling (75% of athletes with conversion disorder developed symptoms in a body part where parents had a symptom). Dissociative Disorders—disruption of functions of consciousness, memory, identity, self-awareness, or perception of the environment, usually in response to extreme stress  Extremely rare  Dissociative Amnesia—inability to remember important information not due to normal forgetting o Stress induced (significant threat to safety or health, like traumatic events) o Does not affect the storage of new information o Psychogenic Vs. Biogenic amnesia  Biogenic amnesia (hitting head during accident) o Memory loss can range form entire life to selective o Often faked by criminals—faked cases tend to last longer. o Dissociative fugue—dissociative disorder involving amnesia and flight from the workplace or home. May involve establishing a new identity in a new location  Dissociative Identity Disorder (DID)/Multiple Personality Disorder o Not Schizophrenia o Very uncommon (probably a few thousand cases) o Maintains 2 or more separate and distinct personalities  Most common is 3 or 4 o In most instances, 6-12 years elapse between when a patient first seeks treatment and the diagnosis of dissociative identity disorder  Most common alternate diagnoses are schizophrenia, depression, and drug abuse o Epidemiology  Primarily women  Generally identified in 20s  Personalities may begin splitting off in youth, sometimes more than one at a time  Subpersonalities can be different sexes, races, ages, and names  Etiology: often, sexual abuse during childhood. Subpersonalities serve a protective role  TX (treatment): hypnosis  Depersonalization Disorder—persistent or recurring depersonalization episodes that involve feeling detached from ones body, and interfere with his life. Detached Anxiety Disorders  Anxiety—general feeling of apprehension characterized by behavioral, cognitive, or physiological symptoms  Prevalence: 19% of men, 31% of women at some point in life  Phobias—intense excessive fear of an activity, object, or situation  Generalized Anxiety Disorder—chronically high level of anxiety, not attached to a specific stimulus o Lifetime Prevalence: 6% o Typical onset: 20s or 30s o Low levels of GABA can cause anxiety  Panic Disorder—most severe anxiety disorder o Physiological: sweating, trembling, heart palpitations o Psychological: believe they are going to die, or going crazy o Etiology: hypersensitivity to suffocation (inherited tendency) o TX: combine drug treatments with cognitive therapy  Obsessive Compulsive Disorder (OCD) o Obsessions: repeated irrational, intrusive thoughts, images, impulses  They know that they are responsible for the thought (do not believe that the thought is being sent at them) o Compulsions: irresistible actions  If you keep the person from engaging in the compulsion, anxiety stays high. Compulsions lower anxiety level  Compulsions often have no apparent connection to the obsession o Etiology: operant conditioning (negative reinforcement when compulsions decrease anxiety) o Runs in families. Identical twins more likely to share the disorder than fraternal twins o Biological: high levels of activity in frontal lobes and basal ganglia o TXP  ERP: exposure and response prevention  SSRIs  Psychosurgery  Posttraumatic Stress Disorder (PTSD)—a reaction to a traumatic or life-threatening situation that is characterized by repeated re- experience of the traumatic event, avoidance of reminders of the situation, emotional numbness, and increased arousal (angry outbursts, trouble sleeping, hypervigilance) o Twice as frequent in women than in men Psychosis  Loss of contact with reality  Often requires hospitalization  2 key disorders: Schizophrenia and Bipolar Disorder Schizophrenia  Literal meaning=split mind (NOT multiple personality)  Epidemiology o Prevalence: 1% o Similar in men and women, but disorder occurs earlier and more severely in men. o Most cases in 20s and 30s (rarely over 50) o Higher rate among lower social classes o Higher rate in inner cities (true not only in USA, but throughout the world)  Symptoms o Positive Symptoms  Delusions: bizarre (ex. Thought broadcasting) vs. non- bizarre (persecution)  A Bizarre delusion is something that cannot happen. Non-bizarre can occur, but unlikely  Hallucinations [to wander in mind]: auditory, visual, olfactory, gustatory, tactile (note: formication)  Auditory is most common, then visual  Most da
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