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Chapter 14

Chapter 14

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Department
Psychology
Course
PSYC 100
Professor
Jens C Pruessner
Semester
Fall

Description
14.1: How are psychological disorders conceptualized and classified? Psychopathology: sickness or disorder of the mind. Thought to be due to demons. People removed to insane asylum. Hippocrates classified mania, melancholia, and phrenitis, due to relative amount of “humors” (bodily fluid).  Psychopathology is different from everyday problems: ¼ Americans has mental disorder in given year, ½ have some form of mental disorder at some point. Only 7% severely affected, suffer from multiple psychological problem considered disorder when it disrupts person’s life and causes significant distress over long period o Psychological disorders are maladaptive: does person act in way that deviates from cultural norms for acceptable behavior? Is behavior maladaptive? Is behavior self-destructive? Does behavior impair social relationships?  Psychological disorders are classified into categories: etiology: factors that contribute to the development of a disorder. Kraepelin recognized not all patients suffer from same disorder, separated mood from cognition disorders. APA published Diagnostic and Statistical Manual of Mental Disorders. Current edition describes disorders in terms of observable symptoms; patient must meet specific criteria to get diagnosed, classified through multiaxial system: calls for assessment along five axes that describe important mental health factors (clinical disorders, mental retardation, general medical conditions, psychosocial/enviro problems, global assessment of functioning). Problem is either/or evaluation – categorical, fails to capture differences in severity. Alternate: dimensional approach: consider mental disorders along continuum, separates disorders that usually go together  Psychological disorders must be assessed: assessment: examination of person’s mental state to diagnose possible psychological disorders, which leads to prognosis. Mental status exam: snapshot of patient’s psyc functioning (emergency room). Clinical interview: interviewer’s skills determine quantity and value of info obtained, express empathy, build rapport, nonjudgmental. o Structured versus unstructured interviews: very flexible, topics of discussion vary, never elicit same info from same patient. In structured interview, standardized questions asked in same order. Formula, Structural Clinical Interview for DSM. o Observation and types of testing: most popular questionnaire for psyc assessment: Minnesota multiphasic personality inventory, 567 true/false items with 1- clinical scales to generate profile, much bias from respondents balanced with validity scales (faking good/bad). Criticized for being inappropriate in other countries or minorities. Neuropsychological testing: patient copies pictures, draws from memory, sorts cards, blocks, etc o Evidence-based assessment: clinicians often choose tests based on their own experience/judgment, instead of formal method such as structured interview. Evidence –based assessment: approach to clinical evaluation in which research guides evaluation of mental disorders, selection of appropriate tests, and making diagnosis, e.g. comorbidity: mental disorders occur together  Psychological disorders have many causes: diathesis-stress model: diagnostic model that proposes that a disorder may develop when an underlying vulnerability is coupled with a precipitating event. Individual can have underlying vulnerability/predisposition (diathesis) to mental disorder, can be bio/enviro, disorder triggered with addition of circumstances that exceed ability to cope o Biological factors: fetus vulnerable, childhood/adolescent exposure to toxins/malnutrition cause risk due to effect on CNS. PET and fMRI show brain regions may behave differently individuals with mental disorders. Neurotransmitters also have role. o Psychological factors: family systems model: considers symptoms within an individual as indicating problems within the family. Sociocultural model: views psychopathology as result of interaction between individuals and their cultures. o Cognitive behavioral approach: views psychopathology as result of learned, maladaptive thoughts and beliefs, due to classical and operant conditioning thouhts/beliefs are types of behavior, can become disorted and produce maladaptive behaviors/emotions, belives thought procfesses are available to conscious mind o Sex differences in mental disorders: alcoholism more likely in males, anorexia more likely in females, schizophrenia/bipolar disorder equally likely. Internalizing disorders: negative emotions, grouped into categories that reflect distress/fear. Externalizing disorders: disinhibitions. o Culture and mental disorders: disorder w/ strong bio component will be more similar across cultures, a disorder influenced by enviro more likely to differ across cultures 14.2 Can anxiety be the root of seemingly different disorders? Anxiety disorder: excessive anxiety in absence of true danger; normal to be anxious in certain situations, abnormal to feel strong chronic anxiety without cause  There are different types of anxiety disorders: high levels of autonomic arousal: tense, apprehensive, depressed, irritable, trouble sleeping, attention span and concentration impaired, bodily symptoms, pointless motor behaviors, atrophy in hippocampus o Phobic disorder: fear of specific object/situation, exaggerated and out of proportion. Specific vs. social (fear of being negatively evaluated by others; aka social anxiety disorder). o Generalized anxiety disorder GAD: diffuse state of constant anxiety not associated with any specific object/event, minor matters, not focused so can occur in response to anything o Posttraumatic stress disorder PTSD: frequent nightmares, intrusive thoughts, and flashbacks related to earlier trauma. Some individuals more at risk than others (genetic marker related to serotonin functioning). PTSD involves inability to forget, attentional bias, emotional event is “overconsolidated” (burned into memory) o Panic disorder: sudden, overwhelming attacks of terror. Several minutes, sweat/tremble, racing heart, chest pain, dizzy, numbness, feeling crazy, higher suicide attempt, likely to develop other anxiety disorders. Agoraphobia: fear of being in situations where escape is difficult/impossible o Obsessive compulsive disorder OCD: frequent intrusive thoughts and compulsive actions. Obsessions: recurrent, intrusive, unwanted thoughts/ideas/mental images. Compulsion: acts that person feels driven to perform repeatedly. Anticipate catastrophe and loss of control, checking helps calm anxiety.  Anxiety disorders have cognitive, situational and biological components o Cognitive components: anxious individuals assume ambiguous/neutral situations are threatening, focus excessive attention on perceived threats, recall threatening events more easily than nonthreatening, exaggerate perceived magnitude/frequency o Situational components: observing other peoples’ fears might generalize o Biological components: some aspects of childhood temperament observed in adult brain (showing amygdala threat response to novel faces) o Causes of obsessive compulsive disorder: OCD may result from conditioning, anxiety paired with event, person engages in behavior that reduces anxiety. Etiology of OCD may be genetic; OCD-related genes may control neurotransmitter glutamate (major excitatory transmitter, causes increased neural firing). Caudate: brain structure involved in suppressing impulses, smaller and abnormal in people w/ OCD, dysfunction causes leak of impulses into consciousness, and prefrontal cortex becomes overactive to compensate. OCD may be triggered by enviro, e.g. streptococcal infection overnight. Maybe autoimmune response damages caudate, producing OCD symptoms. Most likely bio and cognitive-behavioral factors interact to produce OCD symptoms- dysfunctional caudate allow impulses to enter consciousness, giving rise to obsessions, prefrontal cortex becomes overactive to compensate, associates established between obsessions and behaviors that reduce anxiety from obsessions. 14.3 are mood disorders extreme manifestations of normal moods?  There are categories of mood (affective) disorders, depressive (persistent and pervasive feelings of sadness) and bipolar (radical fluctuations in mood) o Depressive disorders: major depression: severe negative moods or lack of interest in normally pleasurable activities, also appetite/weight changes, sleep issues, no energy, difficult concentration, guilt, thoughts of death. Dysthymia: mild to moderate severity, not severe enough be diagnosed as major depression, symptoms less intense o Roles of culture and gender in depressive disorders: “common cold of mental disorders,” leading cause of disability, stigma esp. in developing countries, leading risk factor for suicide. Twice as many women suffer, possible due to multiple roles, overwork, lack of support, men’s symptoms more in line with male gender roles (externalize). o Bipolar disorder: alternating periods of depression and mania. Manic episodes: elevated mood, increased activity, less sleep, big ideas, racing thoughts, distractibility, results in excessive involvement in nice but stupid activities. Hypomanic episodes: creative/productive o Case study of bipolar disorder: K
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