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PSYA02 Post Midterm Lecture Notes 2014

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University of Toronto Scarborough
Alexandra Pohlod

PSYA02 Post Midterm Lecture Notes 2014 #13. Classification of Mental Disorders A Bit of History -clinical psychology, fitting well, functioning well with social structure = good!, however “different” ppl. were often see as schizophrenic ->schizo’s were like intermediaries, seen as voices to heavens ->Joan of Arc schizophrenic, led French to lots of victories, had angels speaking to her, perceived as witch -> how ppl. used to deal with insane->put “crazy” ppl. into mental institutions, most famous called Bedlam Defining “Abnormal” -in its most direct form, abnormal just means anything that deviates from the norm ->however in psychological contexts, the term “maladaptive” is used, meaning person is abnormal in way that causes social problems for them or others (prob.’s that make it hard from them to adapt to society) ->thus abnormal psychology is associated with: an inability to hold a job, marital or family dysfunction, problematic interactions with others The Psychodynamic Perspective -when psychic conflict is too strong for defence mechanisms to deal with in healthy ways, they may actually distort one’s perception of reality or the person will function in ways reflective of an early developmental stage ->this can lead to psychological disorders that include: extreme anxiety, obsessive thoughts & compulsive behaviour, depression, disturbed perceptions & thought disturbances, paralysis or blindness without physical cause Medical Perspective -during 18 /19 centuries, ppl. began to think about psychological disorders as reflecting biological causes, this perspective of “mental illness” remains dominant as rep.’d in own “mental health” program ->3 aspects of this perspective are very powerful in the world: 1. notion that many disorders reflect chemical imbalances 2. notion that drugs can effectively be used to counter these 3. the quest to find genetic links to mental diseases ->although common, imbalance of chemicals is not always cause of mental illness Cognitive-Behavioural Perspective -perspective assumes that many maladaptive behaviours are learned, thus best understood by focusing on potential relevant enviro. factors & person’s perception thereof ->things that are learned can be unlearned & doing so often requires therapist to consider: ->current reinforcement contingencies & manner in which patient thinks -child bedwetting example: -psychodynamic perspective->person feels insecure by parents -cognitive perspective->device that triggers alarm that will wake child up when he/she wets bed (classical conditioning) Humanist Perspective -assumes that maladaptive behaviours arise when ppl. place too much emphasis on gaining +ve self-regard from others ->therapies associated with humanism attempt to show ppl. that they have intrinsic value, can achieve unique potential, respect to extent to guide “client” (patient considered offensive) Socio-Cultural Perspective -highlights role that culture can play in terms of both prevalence & reaction to mental disorders ->what is considered normal in one culture, might be seen as abnormal in another, certain mental disorders might actually be more or less likely (in various cultures) Biopsychosocial Perspective -emphasizes interaction of biological, psychological & sociological factors in causing psychological disorders ->ex. “stress diathesis model” of various mental disorders ->genetic predispositions towards certain disorders, environmental (via cognitive) triggers that translate genotype into phenotype…stress! Classifying Disorders Pros and Cons -medical model typically begins by classification of symptoms (into categories)->pros: may help one find other commonalities related to etiology (cause) of disease, it also may allow better application of treatments that work well on some, but not other, disorders ->but “labelling” ppl. can have strong –ve effects: ->relives ppl. of responsibility for their prob.’s ->can falsely suggest clusters of symptoms ->can result in –ve stereotypes for mentally ill ->can suggest understanding that’s not actually there DSM-IV-TR The Diagnostic and Statistics Manual of Mental Disorders -Axis 1-Major clinical syndromes -Axis 2-Personality disorders -Axis 3-Physical Disorders -Axis 4-Seveerity of Recent Stress (stress diathesis model) -Axis 5-Global Assessment of Functioning (how serious is it impacting life?) #14. Somatoform, Anxiety and Dissociative Disorders The Tightrope of Mental Stabilities -everyone has some level of mental disorder symptoms, mostly normal, but only disturbing when it ruins lives or others ->“tightrope” reflects change in balance, Wernicke’s area can be activated enough that voice is coming from external world->defining symptom of schizophrenia Somatoform Disorders -a person is classified as having somatoform disorder when he/she consistently complains of bodily (health) prob.’s which appear to have no psychological basis ->somatization disorder: chronic, wide ranging complaints of health issues without basis, similar to hypochondriasis (type of anxiety disorder, tends to be notion that once someone hears about disorder, they become convinced that they have it), runs in families, related to alcoholism in males perhaps (tends to go together) ->conversion disorder: blindness, deafness, loss of feeling, neurological paralysis, effects both men & women equally, must be associated with psychological trigger, classically understood by psychoanalytic theory ->difference from lingering (exaggerating symptoms of mental or physical disorders) Anxiety Disorders -panic attacks (1.6 % of pop., women twice as likely), amygdala gets heart rate going (ready) & triggers memory systems, for some ppl., amygdala can be triggered randomly, ppl. with panic attack have no idea what’s causing their panic->anticipatory anxiety: scared panic attack can occur anytime ->periods of acute terror lasting from minutes to hours ->shortness of breath, sweating, dizziness, faintness, feelings of non-reality, death soon! ->often leads to anticipatory anxiety, fear of having panic attack ->sometimes context bound by classical conditioning, or leads to other disorders -phobic disorders: persistent irrational fears of specific objects or situations, again, fear must interfere with one’s life to be considered a true phobia… -obsessive compulsive disorder (about 2%, women more likely): patients experience obsessive thoughts that won’t leave them & compulsive behaviours they can’t keep from performing; they recognize this a problem & wish it would stop (ex. fear of germs, washing hands is rewarded by –ve reinforcement) ->often leads to rituals around such things (as being clean or ordered), obsessive doubt or uncertainty (checkers), fear of doing something prohibited, compulsions fall into checking, counting, cleaning & avoidance->some ppl. “like” their disorder, but for OCD, this isn’t true Dissociative Disorders -anxiety is reduced by sudden disruption in consciousness which, in turn, may cause changes in person’s memory or identity ->dissociative amnesia: memory loss related to some traumatic event (sudden loss, extreme guilt, victim of violence) ->dissociative fugue: similar context but much more extreme change in identity (& often location), sudden dramatic split/change, wanting to become new person ->dissociative identity disorder: patient creates additional personalities to help deal with stress, what most ppl. think as multiple personality disorder #15. Disorders of Emotion -in reality, most people have combination of disorders Major Depressive Disorder -depression is #1 killer of ppl., suicide, OCD can link to depression, excessive worrying, depression “sneaks” into other disorders Clinically Speaking -sad & apathetic mood, feelings of worthlessness & helpless, desire to withdraw from others, sleepless, loss of appetite/sexual desire, lethargy or agitation ->*recall dog example in Lecture #7 ->to be clinically depressed, it has to be chronic & long lasting Incidence Rates -about 1 in 8 women have severe depression, for men, 4.3% experience deep depression ->depression common in adolescents & young teens ->depression has genetic & enviro. component (poverty status, economic stress, 3-4x more likely to be depressed), circumstances of a person’s life matter Bipolar Disorders -bipolar 1: episodes of mania (nonstop orgasm) either by themselves or more commonly, mixed with periods of major depression -bipolar 2: periods of major depression mixed with occasional, less intense periods of mania (hypomanic episodes) Possible Causes Cognitive causes: generally –ve about themselves, which can result in string of self-fulfilling prophecies, *recall Ekman (wearing expression, feeling emotion) ->imagine going to job interview, job helps with financial needs, but you go into interview with –ve thoughts, devaluing self, “I’m boring, uninteresting” mindset, person will then come across as pathetic, weak attitude ->overblow small –ve’s into very large ones, blame situation on stable personal inadequacies (attribution style) & thus feel helpless/hopeless with respect to change, exacerbated by –ve life events, driven to suicide behaviour, no +ve expectations -serotonin reuptake inhibitors (serotonin makes ppl. happy), although neurotransmitters can be played around, they only work in short-term, as a result dependence on drug which becomes less effective over time -depression links to sleep disorders, seasonal affective disorder (biological clock)->solution: light therapy, vitamin C, helps with sleep Pregnancy -new mothers tend to be depressed b/c everybody is so happy for them->mothers feel whole personality has been ripped away from them->solution: understand it’s a tough time & help out! #16. Schizophrenia -it is NOT multiple personality disorder, schizophrenic ppl. show disordered thought patterns Schizophrenic Disorders -group of psychological disorders involve distortions of thought, perception & emotional; bizarre behaviour & social withdrawal->means “split mind” but doesn’t involve multiple personality disorder, affects about 1% of Canadians ->can’t function (come to terms) of realities (school, holding job for instance), end up separating themselves from society ->common (trouble with communicating), more convincing to ppl. that it’s biological (can be treated but not fully eliminated) ->paranoid schizophrenics (more dangerous) Age of Onset & Hospitalization -more prevalent in males than females->for females, tends to hit at middle age (40-50’s), men (late 20’s-early 30’s), but schizophrenia can show up at any point Positive Symptoms -hallucinations (typically auditory), +ve in the sense of addition (not good) ->schizophrenics do not typically see what doesn’t exist, but rather hear things ->distinction of what’s happening in mind is blurred along with reality (having conversations in mind or reality…?) ->inner voices give rise to delusions of: -persecution (everyone is out to get me! paranoia) -control (associated with auditory hallucinations, feel as though something/someone else is controlling their behaviour, in their minds, evil acts are considering cleansing) -grandeur (impression that self is an important person, “I am God”) ->when committing crime, did person distinguish from right or wrong?, schizophrenics are mostly isolated though…panhandling for instance ->most of these symptoms can go away Negative Symptoms -things that schizophrenics lack that most ppl have ->disorganized speech, things don’t make total sense, communication is not clear ->lack of emotion, neither too happy or sad, although there’s intensity (perhaps from disorganized speech), response is not what they expect, t/f frustration, no proper emotional responsiveness->lack of energy; socially inept, inability to maintain relationships/friends, hard time holding job ->-ve symptoms can’t go away (as long as person is on meds, it removes some element of danger, but the person is still going to have trouble interacting) Types of Schizophrenia -catatonic, residual, paranoid, disorganized, undifferentiated ->paranoid most common (problem of separation b/t fantasy & reality), can build really complex ideas but then lose distinction b/t what is seen & what only happened in the mind, auditory hallucinations ->disorganized: trouble with communicating, emotional tendency is low, more –ve than +ve, unpredictable behaviour ->catatonic: immobility ->undifferentiated: shows more than one type of schizo ->residual type follows one of the others & is marked by only –ve symptoms (symptoms left after medication) ->reactive type marked by rapid onset & brief duration (episodes), caused by stresses, can almost go away but will it be triggered again, relapses?, not as common ->process type marked by gradual onset & poor prognosis (prediction), more common, will always need management Genetic Links -rates of schizo among relatives of schizophrenic patients’ (what’s the likelihood parents, children will be schizophrenic…etc…) ->the more into family unit, the higher rates are (identical twins almost 60%), proof of being more likely to accept biological cause Dopamine Hypothesis -antipsychotic drugs (like chlorpromazine) block dopamine antagonist receptors, long term usage (& high dosage) of phenothiazine’s often develop Parkinson-like symptoms (tardive dyskinesia, tendency to drool caused by meds) ->amphetamine psychosis resembles schizophrenia ->blocks dopamine antagonist transporters, thereby raising dopamine antagonist levels, exacerbating schizo The Role of the Family Double blind-situation in which parent encourages child to engage in some behaviour, but the gives “mixed signals” by not supporting them when they actually do Express emotion-expressions of criticism, hostility & emotional over-involvement by family members ->leads to relapse ->environment matters, like mentioned before, it’s a mix of genetic & environmental influences #17. Personality Disorders Anti-Social Personality Disorder -a person is classified as having a personality disorder if their abnormalities of behaviour impair their social or occupational functioning, ex. Joker, Paul Bernado of UTSC Theory of Mind and Empathy -*recall theory of mind->everyone can experience world through eyes of another, important characteristic of deceit & lying (psychopaths are very good at manipulating) ->hearing someone crying for help, bystander will automatically feel that (empathy)->if person in need stops feeling suffering, so does bystander (psychopath lacks this, sharing feelings) ->emotionally separated (ex. killing cow for meat->slower process, suffering lingers) ->to psychopaths, having lack of empathy is a superpower, none of them want treatment, think normal ppl. are pathetic Anti-Social Personality Disorders -behavioural analysis, are clusters of behaviours reliable? ->psychopaths seem to be friendly & fun (superficial charm), always thinking big (grandiose), pathological lying (telling lies person wants to hear), it’s hard to challenge psychopaths, they simply just smile & shrug it off ->failure to accept responsibility, impulsive, non-realistic goals, criminal versatility, trouble with relationships unless they’re with other psychopaths ->Shock-wrong-cash-experiment, when psychopaths get shocks, it doesn’t scare them, however when it comes to money, they are very motivated, specifically power ->sympathetic nervous system when losing money, psychopaths get anxious -environmental causes vs. cognitive causes, lawyers similar to psychopaths (motivated to defending someone despite committing severe crime b/c they want to win cases) Borderline Personality Disorder -efforts to resist perceived abandonment (minor changes), intense but short-lived relationships ->sudden shifts in self-image (goals, values, aspirations), impulsivity (irresponsible spending, binging, substance) ->suicidal or self-mutilating behaviour (linked to repeatedly victimized, way of empowerment->at least person is doing it to themselves vs. other ppl. doing it to them) Substance-Related Disorders -overall prevalence is 26.6% (3.8%/year…15% alcohol)-N. America ->includes addiction while substance-induced disorders are less extreme but still related to health, occupational/social prob.’s ->it’s not always clear to distinguish illness from choice, some ppl. think substance- related disorders is illness while others think it’s personal choice ->addiction: feels like illness if it’s ruining life ->genetic & psychological causes: steady drinkers vs. binging (either really drunk or really sober) ->cognitive causes (disordered thinking) #18. History and Insight Therapies History -extreme way of dealing with mental illness: witch doctors celebrated, prophets, were they schizophrenic? (speaking to spirits) ->trephining->drilling hole through skull to let “evil spirits” would leave the mind ->tucking away mentally ill into asylums (bedlam), restraining chair, mechanisms on head to reduce sensory input, keeps them calm ->Pinell, a psychologist, was put in charge of an asylum, decided to take ppl out of asylum & treated them humanely, noticed patients got much better than being chained (giving them purpose, sense of value)->humanist movement towards treating the mentally ill ->Mesmer, Charcot & Freud, all medical doctors who were struck by fact who had odd conditions who looked biological but didn’t seem to have biological causes ->magnets, believed to have mystical powers, Mesmer believed magnets could cure mental illnesses, he filled pools of water with magnetic rods, believed it would treat mentally ill by taking a dip ->Charcot showed interest, but then he thought it wasn’t magnets, he gravitated towards idea of hypnotism ->importance was that Mesmer tells ppl to go through process, power of suggestibility, having doctor/medical official telling patient such a process will make them feel better, strong claims believed to cure them ->Freud thought hypnosis was cool at first, but eventually leaned towards dreams b/c suggestibility continues outside of hypnotic trance, despite certain things said by patients which were obviously wrong Modern Therapies -insight, group, drug & cognitive-behavioural therapies Insight Therapies -emotional irregularities are symptoms, reflection of some true underlying issue, to solve illness, get to issue! -the reason it lingers is b/c person hasn’t consciously dealt with it, t/f to some level person doesn’t want to deal with it ->by taking too of a direct approach to issue, defense mechanisms becomes aroused -assumes the ppl have learned maladaptive thought patterns & emotions, which are revealed in maladaptive behaviours, ->behaviours reflective of some deeper psychological issue & when patient understands true cause (gains insight), the maladaptive behaviours will subside ->psychoanalysis: free association, dreams, other projective tests (ink blot for ex or drawings); therapeutic setting: resistance (person doesn’t want to play along, not enjoying themselves), transference (when patient talks to therapist as if feelings were directed towards someone else, channelling aggression to therapist) & counter- transference (every therapist is a human being, when therapist starts responding in the way patient wants to, sexual behaviour with client for instance, it becomes a problem of transferring behaviour, ruins therapeutic relationship, heavy content!) Humanistic Therapy -Carl Rogers, client-centered therapy ->generally non-directive in a manner meant to help “client” essentially help themselves, therapists provide support, encouragement & acts to help client achieve smallest level of incongruence (distance b/t who they are & who they would like to be) ->client has to do most of the work, therapist does not order client around, but rather helps him/her explore pathways of what he/she wants to be, to be a great friend…ask questions about feelings->reflective behaviour, help them think through problem space ->Gestalt Therapy: emphasizes unity of body & mind, helping client get in touch with their feelings, mindfulness-tuning into feelings & effects, get in touch with feelings of anger & depression ->ex. empty chair technique: take out true aggression on chair, good connection with understanding feelings of self ->much more symptom based Evaluation of Insight Therapies -limits->to benefit from insight therapies, client must be intelligent, articulate, motivated (able to play along) & rich enough to spend multiple days or week or even years, esp. psychoanalysis, not helpful for those who don’t want therapy (like schizo ppl) ->not many scientific studies assessing effectiveness but there are some which show that undergoing therapy is more effective than not going ->however it’s not as effective as cognitive-behavioural therapies #19. Behavioural and Cognitive Behavioural Therapies Therapies Based on Classical Conditioning -*recall that many anxiety disorders (ex. phobias) are thought to have developed via classical conditioning, thus, it should be possible to use classical conditioning to counter these disorders ->systematic desensitization: technique designed to eliminate unpleasant emotional response by feared object or situation & replace it with an incompatible one (like relaxation); reinforce someone to do something positive Systematic Desensitization 1. Relaxation->learn to relax->associate feeling with trigger & then practice using trigger (being anxious & relaxed can’t occur simultaneously) 2. Hierarchy of fears->create hierarchy->go through it slowly using trigger->one can’t progress until he/she can remain relaxed on the previous step Hierarchy of Fears -ex. fear of public sp
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