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Chapter 14

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Steve Joordens

Chapter 14  MEDICAL MODEL – conceptualization of psychological disorders as diseases that, like physical diseases, have biological causes, defined symptoms, and possible cures o Diagnosis through symptoms to find underlying syndrome  SYNDROME - a coherent cluster of symptoms usually due to a single cause  DSM-IV-TR – a classification system that describes the features used to diagnose each recognized mental disorder and indicates how it can be distinguished from other, similar problems o Diagnostic and Statistical Manual of Mental Disorders(Fourth Edition, Text Revision) o Three elements that must be present for a cluster of symptoms to qualify as a potential mental disorder  Manifested in symptoms that involve disturbances in behaviour  Symptoms associated with significant personal distress or impairment  Symptoms stem from an internal dysfunction (bio, psych, or both) o Recommends that diagnoses include a global assessment of functioning – as a percentage of how the person is doing compared to normal o Some diagnoses may depend on the clinic setting  COMORBITY – co-occurrence of two or more disorders in a single individual  Medical model – all disorders should have a common prognosis – typical course over time and susceptibility to treatment and cure  Mental disorders are a combination of biological, psychological and environmental factors o Biological – genetics, biochemical imbalances, structural abnormalities of the brain o Psych – maladaptive learning and coping, cognitive biases, dysfunctional attitudes o Environment – poor socialization, life circumstances, soc/cult inequalities  DIATHESIS-STRESS MODEL – a person may be predisposed for a psych disorder that remains unexpressed until triggered by stress  Intervention Causation Fallacy – assumption that if a treatment is effective it must address the cause of the problem – not a general rule o Sleeping pills help you sleep but don’t settle your mind on what was keeping you up  Mental disorders DO NOT have a single internal cause – they have a multitude of factors  Psychiatric labels have negative consequences since may of these labels carry the baggage of negative stereotypes and stigma o Education does not dispel the stigma that mental diseases have  Rosenhan experiment where he and his associated claimed to hear voices and went to different mental hospitals o Took an avg of 19 days to be released with a labelled of schizophrenia in remission  Mental patients are typically no more likely to be violent than anyone else o The label becomes a kind of prison that makes it difficult to return to normal life  Can affect how the person views themselves – attitude of defeat and a failure to work towards recovery  --------------------------------------------  The study of psychological disorders follows a medical model in which symptoms are understood to indicate an underlying disorder.  The DSM-IV-TR is a classification system that defines a psychological disorder as occurring when the person experiences disturbances of thought, emotion, or behavior that produce distress or impairment and that arise from internal sources.  The classification system includes a global assessment of functioning and a set of categories of disorder, but comorbidity of disorders is common.  Many psychological disorders arise from multiple causes or as a result of the interaction of diathesis (internal predisposition) and stress. It is a common error to assume that an intervention that cures a disorder reflects the cause of the disorder.  -------------------------------------------------  ANXIETY DISOERDER – the class of mental disorder in which anxiety is the predominant feature o DSM-IV-TR – generalized anxiety disorder, phobic disorders, OCD  GENERALIZED ANXIETY DISORDER (GAD) – chronic excessive worry is accompanied by three or more of the following symptoms: restlessness, fatigue, concentration problems, irritability, muscle tension, sleep disturbance o Worrying produces loss of control that can erode self-confidence so that simple decisions seem really serious o Biological and psychological factors  Bio – neurotransmitter imbalance  Psych – anxiety provoking situations – low income, large cities, environments rendered unpredictable by political/economic strife  PHOBIC DISORDERS – characterized by marked, persistent, and excessive fear and avoidance od specific objects, activities, or situations o SPECIFIC PHOBIA – irrational fear of a particular object or situation that markedly interferes with an individuals ability to function  Animals; natural environments; situations; blood, injections, and injury; others such as illness and death o SOCIAL PHOBIA – irrational fear of being publically humiliated or embarrassed  Can be situational or generalized – try to avoid situations with unfamiliar people  Can develop in childhood, emerges between early adolescence and the age of 25, higher rates found the undereducated and low income o PREPAREDNESS THEORY – people are instinctively predisposed towards certain fears  Phobias are likely to form for objects that evolution has predisposed us to avoid  Supports heritability of phobias o Shy infants more likely to develop phobias, also some biological sources  Abnormalities in dopamine, serotonin levels, high activity levels in the amygdala  PANIC DISORDER – sudden occurrence of multiple psychological and physiological symptoms that contribute to a feeling of stark terror o Shortness of breath, heart palpitations, sweating, dizziness, depersonalization, derealisation, fear of immediate death o AGORAPHOBIA – specific phobia involving fear of venturing into public spaces  Many people don’t fear the public space, fear having a panic attack with strangers who will view them negatively and not help them o People who are high in anxiety sensitivity have an elevated risk for experiencing panic attacks o People with panic disorder were more sensitive to sodium lactate, which produces rapid, shallow breathing and heat palpitations  Obsessive-compulsive disorder (OCD) – repetitive, intrusive thoughs (obsessions) and ritualistic behaviours (compulsions) designed to fend off those thoughts interfere significantly with an individual’s functioning o Obsessive thoughts typically produce anxiety, the compulsive behaviours reduce it o Not the same as ritualistic checking to make sure something is off – the O and C of OCD are intense, frequent and experienced as irrational and excessive  Common Os – contamination, agreesion, death, sex, disease, orderliness  Common Cs – cleaning, checking, repeating, ordering/rearranging, counting o Os for people with OCS derive from concerns that could pose a real threat o Moderate heritability for OCD, no biological mechanisms for it  ----------------------------------------------  People with anxiety disorders have irrational worries and fears that undermine their ability to function normally.  Generalized anxiety disorder (GAD) involves a chronic state of anxiety, whereas phobic disorders involve anxiety tied to a specific object or situation.  People who suffer from panic disorder experience a sudden and intense attack of anxiety that is terrifying and can lead them to become agoraphobic and housebound for fear of public humiliation.  People with obsessive-compulsive disorder experience recurring, anxiety- provoking thoughts that compel them to engage in ritualistic, irrational behavior.  -------------------------------------------------  MOOD DISORDERS – mental disorders that have mood disturbance as their predominant feature – depression and bipolar disorder  MAJOR DEPRESSIVE DISORDER – aka unipolar depression is characterized by a severely depressed mood that lasts 2 or more weeks and is accompanied by feelings of worthlessness and lack of pleasure, lethargy, and sleep and appetite disturbances o DYSTHYMIA – same cognitive and bodily problems with depression are present, but they are less sever and last longer, persisting for at least 2 years o DOUBLE DEPRESSION – moderately depressed mood that persists for at least 2 years and is punctuated by periods of major depression  SEASONAL AFFECTIVE DISORDER – recurrent depressive episodes in a seasonal pattern – depression in fall/spring  Major depressions last 12 weeks o Women diagnosed at a rate twice as often as men – socioeconomic standing, hormones, postpartum depression (childbirth)  Women accept, disclose and ruminate on negative emotions - higher rates just mean they are more open to face problem  Depression – Biological o Heritability rates vary depending on severity o Increased neurotransmitter norepinephrine and serotonin can reduce it  Prozac and Zoloft o May involve diminished activity in the left prefrontal and increased activity in the right prefrontal  Severe depression – diminished activity in the prefrontal regions of the cerebral hemisphere – esp on left side  Depression – psychological o HELPLESSNESS THEORY – individuals who are prone to depression automatically attribute negative experiences to causes that are internal (their own fault), stable (unlikely to change), and global (widespread)  BIPOLAR DISORDER – an unstable emotional condition characterized by cycles of abnormal, persistent high mood (mania) and low mood (depression) o Manic followed by depressive in 2/3 of patients  Depression clinically indistinguishable from major depression  Manic must last for a week to meet DSM requirements • grandiosity, decreased need for sleep, talkativeness, racing thoughts, distractibility, and reckless behaviour o Rapid cycling – 4 mood episodes every year o A significant minority are highly creative, artistic, or otherwise outstanding in some way o Biological  Concordance from 40-70% in identical twins, 10% in fraternal  Polygenic – arising from the interaction of multiple genes  Biochemical imbalances o Psychological  Stressful experiences precede episodes  Neuroticism and conscientiousness help predict increases in bipolar symptoms over time  ---------------------------------  Mood disorders are mental disorders in which a disturbance in mood is the predominant feature.  Major depression (or unipolar depression) is characterized by a severely depressed mood lasting at least 2 weeks; symptoms include excessive self- criticism, guilt, difficulty concentrating, suicidal thoughts, sleep and appetite disturbances, and lethargy. Dysthymia, a related disorder,
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