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PSYA02 - CH 13 AND 14.pdf

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Steve Joordens

13.1 Defining and Classifying Psychological Disorders Medical model-using understanding of medical conditions to think about psychological conditions, psychological disorders have symptoms, probably causes, likely outcomes, preventive measures, interventions & treatments ->throughout history/various cultures, other explanations have been proposed for what is now called psychological disorders ->ex. someone who experiences hallucinations would likely be diagnosed with psychological disorder in the States but in another place/time, the person might be viewed as possessed by a curse/evil spirits -*recall biopsychosocial model: ->while a biological factor for depression includes disrupted activity of neurotransmitters (like serotonin), psychological factors include persistent –ve beliefs about self/feelings of hopelessness ->social factors for depression can include impoverished communities or stressful family problems Defining Abnormal Behaviour Abnormal psychology-study of mental illness, the term “abnormal” for ex. can refer to someone who cuts themselves until he/she sustains serious injury (few ppl. inflict damage on themselves)->that person shows maladaptive behaviour-hinders person’s ability to function in work, school, relationships or society ->American Psychiatric Association (APA) provides 3 main criteria to ID maladaptive behaviour: 1. Causes distress to self or others 2. Impairs ability to function in everyday activities 3. Increases risk of injury, death, legal problems or punishment for breaking rules/other bad consequences -to diagnose psychological disorders, psychologists/psychiatrists use Diagnostic and Statistical Manual for Mental Disorders 4 edition (DSM-IV)-manual (created by APA) that establishes criteria for mental disorder diagnosis, offers set of clear guidelines to determine presence/severity of about 350 mental disorders ->for each disorder, guidelines show 3 important pieces of info: 1. Set of symptoms 2. Etiology-origins or causes of symptoms 3. Prognosis-how symptoms persist or change over time (with/without professional treatment) ->DSM-IV uses 5 divisions (axes) to characterize psychological disorders, axes are broad categories divided into many subtypes ->ex. Axis 1 includes mood/anxiety disorders; anxiety disorder is general category while phobias & post-traumatic stress disorder (PTSD) are specific types of anxiety disorders ->diagnostic criteria identify a likely cause, psychological experiences that follow & time course for symptoms, info helps patients decide whether patient should be diagnosed with disorder, a diff. disorder or none at all -biopsychosocial model proves to be useful in understanding mental health, many insurance companies will not cover treatment for mental health prob’s without formal diagnosis -limits to DSM-IV: mental health professionals do not all agree on how to classify disorders ->often disorders are based on observing patients instead of more objective indicators of mental health (such as genes, neurotransmitters or brain abnormalities) ->t/f subjectivity can result & ppl. may fake psychological prob.’s th -so 5 edition of DSM will probably include genetic advances (contributing to thychological disorders)->DSM-IV treats most symptoms as either having it or not, so 5 edition may have broader range of symptoms & their severity -also distinction b/t normal & abnormal does not reflect complexity of human behaviour, symptoms can consist of typical thoughts/behaviours but they’re more severe/long lasting than usual (may even occur in inappropriate contexts without clear reasons)->dimensional view of psychological disorders ->ex. someone who unusually stressful experience that brings out anxiety may be fine after several days, but when anxiety gets severe & long-lasting (changing how person leads his/her life), then condition may be psychological disorder -categorical view (of psychological disorders)-notes different mental conditions as separate types, disorder is not just an extreme version of normal thoughts/behaviour but different altogether ->ex. Down syndrome (involves unusual genetic condition of extra 21 chromosome & is linked so a person can’t have “partial” form of this disorder) ->whereas dimensional disorders like Post Traumatic Stress Disorder (PTSD) show range of symptoms Mental Health in the Public Sphere -2 mental health issues include: insanity defense & public perception of mentally ill -the term insanity depends on legal definitions (varying by state in US)->insanity defense-legal strategy of claiming defendant was unable to differentiate b/t right & wrong when criminal act was committed -plea “not guilty by reason of insanity” is known as M’Naghten rule Labelling, Stigma and Mental Disorders -DSM-IV provides labels for psychological disorders but despite indicating symptoms, probable causes & potential treatments, labels can cause stigmatization -stigmas are –ve stereotypes on what it means to have psychological disorder, can lead to discrimination & unjustified fears ->labels can lead ppl. to misinterpret normal behaviour as symptoms of disorder ->ex. study: David Rosenhan was psychologist who investigated 8, normal/healthy individ.’s who volunteered to go to psychiatric hospitals with complaints about auditory hallucinations ->the 8 “patients” were admitted b/c of schizophrenia or manic depression (bipolar disorder), although after admission, the “patients” behaved normally YET they remained hospitalized for about 19 days (initial diagnosis led hospital staff to misinterpret normal behaviour as illness) -question: how diagnostic label affects person’s self-perception ->study: psychology lecturer Jill Holm-Denoma recruited 53 volunteers seeking treatment for 1 time, participants rated +ve/-ve emotions before & after intake sessions, before & after feedback sessions (informed/educated about diagnosis) & one before starting treatment session ->+ve emotions increased significantly after intake session, increasing again after feedback, no huge changes in –ve feelings so conclusion: learning about one’s own diagnosis could increases +ve emotional experiences during treatment -advantages of labels: crucial in ID’ing/describing problems encountered, labels can also help ppl. understand own situation & can hold out hope for successful treatment -disadvantages of labels: prejudice, misinterpreting behaviours *importance of labeling research: personal contact/knowledge of biopsychosocial explanations of mental illness associated with less stigma st ->when a person is educated about 1 -person experience of mental illness, he/she shows greater acceptance than simply learning mental illness facts Are Symptoms Universal? -Americans who return from war in Iraq/Afghanistan suffer PTSD but also, survivors around the world of major disasters are at risk for developing PTSD too ->ex. difference in cognitive/emotional symptoms: while US war veterans tend to report difficult internal experiences (like flashbacks), 2004 Asian Tsunami survivors likely to experience symptoms beyond individual (worries focused on families/communities) ->to truly understand PTSD, biopsychosocial model must be examined b/c although physical stressors can be similar, culturally relevant experiences/terms should be noted to help those cope with trauma 13.2 Personality & Dissociative Disorders -mental health professionals ID personality disorders as particularly unusual patterns of behaviour for one’s culture that’s maladaptive, distressing to oneself or others & resistant to change ->sometimes personality disorders are observed in ppl. who may be difficult to get along with yet pose no threat to anyone ->other ex’s.: some ppl. feel no empathy towards others (even in stressful situations), others hold excessive expectations of gaining attention & will feel severely rejected if demands aren’t met; as well, ppl. can become rapidly attached to someone only to reject that person (sometimes violently) at any moment ->these examples are dimensional qualities (one may apply to anyone at some point so it’s important to note the actual disorders representing extreme cases) ->table of varieties of personality disorders on next page -the core of any personality disorder is emotional dysfunction ->ex. borderline personality disorder (BPD)-characterized by intense extremes b/t +ve & -ve emotions, an unstable sense of self, impulsivity & difficult social relationships ->a person with BPD may fall in & out of love or love/hate their friends quickly, so no matter how much someone means to that person, there’s going to be conflict in the relationship ->BPD ppl. can become paranoid (suspecting everyone else has similarly unpredictable feelings), fear of abandonment usu. very intense, may drive person to extreme to avoid losing relationship (can lead to risky sexual behaviour in terms of wanting security) ->an important feature of BPD is tendency towards self-injury (cutting, burning, may appear to be suicide attempts, sometimes they are, sometimes they aren’t) Narcissistic personality disorder (NPD)-characterized by an inflated sense of self-importance, an intense need for attention & admiration, as well as intense self-doubt/fear of abandonment, little to no room for empathy ->ppl. with NPD known to manipulate/arrange relationships to make sure own needs are being met (regardless of degree of impact on others) ->ex. students with narcissistic tendencies more likely to engage in academic dishonesty (sense of entitlement allows them to cheat without feeling guilt) Histrionic personality disorder (HPD)-characterized by excessive attention seeking & dramatic behaviour (like an actor/theatrical performance), usu. very successful at drawing ppl. in by being flirtatious, provocatively sexual & flattering, simply playing roles (they believe) necessary to be centre of attention ->ppl. with HPD can show extreme shallowness & emotional immaturity Antisocial Personality Disorder Antisocial personality disorder (APD)-condition marked by habitual pattern of willingly violating others’ personal rights (with little to no empathy/remorse) ->difficult to deal with b/c APD ppl. are often alarming & are rarely motivated to change -APD ppl. tend to be physically/verbally abusive & finding themselves in trouble with the law, men 3 more times likely to be diagnosed with APD than women, symptoms usu. appear during childhood, patterns of harming animals, destroying property, stealing & deceit ->APD is not a DSM-IV diagnosis, the term psychopath is more familiar (but more accurately, psychopath is a person who shows cognitive/emotional qualities of egocentrism, cold-heartedness & manipulative tendencies, both APD & psychopathy have similar set of abnormal personality traits -serial killers rep. only small subset of ppl. with antisocial/psychopathic tendencies, ppl. with APD can be found everywhere -researchers have found ppl. with antisocial personality disorder are under-reactive to stress ->ex, flash of light or loud sound startles most ppl. but those with APD show weak startle responses ->study: researchers recorded electrical signals of eye blink muscles while presenting disturbing images to group of ppl. with & without APD, results: -similar pattern found when psychologists compared ppl. with psychopathy (who had been convicted of violent crimes) with non-psychopathic controls involving aversive classical conditioning ->both groups looked at short presentations of photos of human faces (conditioned stimulus) followed by brief buy painful application of pressure to body (unconditioned stimulus ->what should’ve happened: participants will acquire –ve emotional reaction (conditioned response) to faces ->although control group found experience uncomfortable, ppl. with psychopathy didn’t react like this, showed very little physiological arousal, seemed to not mind looking at pictures of faces paired with pain -not all APD ppl. are violent criminals, antisocial qualities can be found in leaders of huge businesses->ex. Wall Street broker Bernard Madoff admitted stealing billions of $ from investors who trusted him, he showed no remorse for ruining ppl’s fortunes & charities (although not violent crime, level of deceit & egocentrism is psychopathic) -*importance: ppl. with APD tend to be highly resistant to psychological therapies, b/c of the high level of danger they pose, drug treatments may be needed; antisocial patterns often detectable during childhood/teen years so therapies can be beneficial if started at early age -it’s often difficult to ID causes of personality disorders b/c they seem to come up from multiple causes over long period of time, psychologists speak generally about type of events that contribute to personality disorders, it’s possible for 2 ppl. to develop same symptomatic thoughts/behaviours through entirely diff. routes -in terms of psychological factors: ex. NPD ppl. seek to avoid –ve attention b/c of possible depressive reaction, in HPD ppl., those engaging in flattery & provocative feeling avoid –ve feeling of being unnoticed (more likely to resort to such behaviours in the future, even at expense of developing genuine relationships) ->adults with psychopathy & children with conduct disorders (often preceding psychopathy) have difficulty learning tasks that require decision making & following of complex rules ->ex. brain imaging studies show children with conduct disorders perform worse at aforementioned tasks & have reduced activity in frontal lobes compared with healthy control groups & even those with ADHD (attention-deficit/hyperactivity disorder) -in terms of sociocultural factors: children begin developing social skills/emotional attachments at home & in local neighbourhood, t/f trouble while growing up can lead to psychopathy & APD ->since such ppl. have history of being treated like objects (rather than sensitive human beings), they may not practice empathy on others (including animals) ->less severe of BPD is invalidation-child’s caregivers didn’t respond to his/her emotions as if they were real/important, t/f ppl. with BPD can’t ID/control emotions, thus reacting more strongly to everyday life stressors -in terms of biological factors: it seems that # of specific genes contribute to emotional instability through serotonin systems in brain & unique activity in limbic system/frontal lobes (brain regions associated with emotional responses & impulse control) Comorbidity-presence of 2 disorders simultaneously, or presence of 2 disorder that affects one being treated ->ex. person being treated for heart disease may also have diabetes, t/f presence of both can complicate treatment ->substance abuse is often comorbid with personality disorders; comorbidity rates have led some psychologists to believe that DSM-IV ID’s too many diff. types of personality disorders ->however for APD & BPD, these disorders are easy to distinguish & most reliable to diagnose Dissociative Identity Disorder -dissociative experiences-characterize by sense of separation b/t self & surroundings (may happen when focusing on one activity or daydreaming) -in extreme case, there’s dissociative disorder-category of mental disorders characterized by split b/t conscious awareness from feeling, cognition, memory & identity, conditions: ->dissociative fugue: period of extreme autobiographical memory loss, person may go as far to develop new identity in new location with no recollection of past ->depersonalization disorder: belief one has changed in important way (possible ending to be “real” ->dissociative amnesia-severe loss of memory, usu. for specific stressful event (no bio cause for amnesia present) -most familiar of dissociative disorder category: dissociative identity disorder (DID or multiple personality disorder)-person claims his/her identity has split into one or more diff. alter personalities (alters), can be so strong that 1 alter may have no memory of events experienced by other alters -most cases, dissociative disorders thought to be brought on by extreme stress. during traumatic episode (like sexual assault), person may try to block out experience & focus on another time/place ->psychologists speculate that with repeated experiences, dissociation can become way of coping with trauma, events generally. reported include elements of violence, intentional humiliation (rape, forms of sexual torture) -disorder is rare, those who have DID <1% -DID is hard to test for, an approach to testing is to check for memory dissociations b/t alter ID’s ->ex. study: patients viewed words/pics & were tested for recall of stimuli either when they were experiencing same alter as when they learned, or when they were experiencing diff. alter ->results: some types of learning don’t transfer b/t alter ID’s (t/f 2 separate ID’s) -another approach is to record patterns of brain activity ->study: using positron emission tomography (PET), it was found that there was differing frontal lobe activity for ppl. with DID while experiencing each of their alters ->however, aforementioned don’t provide solid evidence for biological basis of DID -physical cause of symptoms of DID have never been found (t/f hard to test objectively), it’s much easier to fake self-reports than to fake something like heart attacks (for instance) -historically, #’s of those diagnosed with DID have risen & 80% of those with DID unaware of having it before therapy, suggesting origins in therapy rather than response to trauma -increases awareness allowed pro’s to diagnose DID more effectively & increase of DID diagnoses is attributable to changing societal/cultural effects (like popularization of film called Sybil, which told true story of woman with DID->DID diagnoses rose after film was released) -DID has strong sociocultural component, in 1990 psychologists began diagnosing patients with DID when disorder was described by North Americans ->in India, DID patients are believed to switch alters upon awakening (in comparison to Americans with DID switching alters upon suggestion) -validity of DID depends on public belief (those with disorder seem to repress their trauma) ->however studies concluded that any forgetting that did happen can be explained by infantile/childhood amnesia (too young to rmb.) or just normal forgetting; most trauma victims rmb. their experiences, t/f unlikely such experiences lead to DID Ch. 13.3 Anxiety and Mood Disorders -when it comes to mental disorders, ppl. typically think of signs that something “isn’t right” about person’s behaviour->what follows can be gradual unfolding of more noticeable personality or behavioural/emotional prob.’s ->cases in which young children exposed to bacterial streptococcal infection, shortly after exposure children quickly developed symptoms of obsessive-compulsive disorder (OCD-including extremely repetitive behaviours & having irrational fears/obsessions) ->when immune system reacts to bacterial infection, cells in caudate (brain part related to impulse control) becomes damaged Anxiety Disorders Anxiety disorders-category (of disorders) involving fear/nervousness that’s excessive, irrational & maladaptive, most frequently diagnosed in U.S. -everyone experiences anxious feelings, based on normal physiological/psychological response to stressful events known as recall: *fight-or-flight response (physical changes: pulse increases, increased respiration, sweaty hands), common to all animals, adaptive response to threats (like predators) -*distinction b/t typical psychological state & disorder combines extremes in duration & severity & a disordered state can be disproportionate response to real-life events or without any previous event -what separates anxiety disorders from other forms of anxiety is combo of unjustifiable degree, duration & source of anxiety->anxiety disorders create distress for person & interferes with normal daily functioning Types of anxiety disorders: Generalized anxiety disorder (GAD)-involves frequently elevated levels of anxiety that aren’t directed or limited to any specific situation, anxiety is generalized to anything ->ppl. with GAD often feel irritated (difficulty sleeping & concentrating), but what makes it distinct from other anxiety disorders is that GAD ppl. often struggle to ID specific reasons for why he/she is anxious ->despite resolving specific issue, anxiety becomes redirected toward another prob., doesn’t seem to go away, major life changes commonly precede GAD Panic disorder-marked by repeated episodes of sudden, very intense fear, anxiety occurs in short periods but can be much more severe than GAD ->key feature is panic attacks-brief moments of extreme anxiety including rush of physical activity paired with frightening thoughts ->escalates when fear of death causes increased physical arousal, the symptoms feed frightening thoughts, rarely goes on for +10 min. (eventually returning to more relaxed state) -ppl. with panic disorder often develop intense fear panic will strike again->can lead to agoraphobia-intense fear of having panic attack or lower-level panic symptoms in public ->t/f ppl. may start avoiding public settings to avoid embarrassment/trauma associated with panic attack, extreme form: person stays inside their home almost permanently Specific Phobias Phobia-severe irrational fear of very specific object/situation (compared to GAD where anxiety can be applied to almost any situation)->best known form of phobia->specific phobias-involve intense fear of object, activity or organism -phobias developed through unpleasant experiences, ex. person bitten by dog might develop phobia of dogs ->however majority of phobia triggers are objects/situations ppl. need to fear (or at least be cautious about), t/f psychologists believe there’s genetic component to phobias from evolutionary history (biologically predisposed to fear some objects) -approach to studying how genetics influence fear/anxiety comes from selective breeding techniques: group of researchers tested strain of mice for fear conditioning, ranked mice from least to most easily conditioned (used classical conditioning in which mice heard tone followed by electrical shock) ->fear measured by length of time mice held still in fear (in response to tone) or freezing in place -most fearful mice then allowed to breed (with each other) across 4 generations, least fearful also paired up & bred, see diagram on next page -although study of mice shows how genes can be selectively bred to increase susceptibility to acquire fear responses, it doesn’t specify how anxiety/fear is coded in human genome ->*recall that objects/events ppl. tend to fear have been around long enough to influence human genetic makeup (explains why ppl. have phobias of snakes or spiders rather than phobias of guns) -*importance: phobias have genetic component, by isolating genetic tendencies & determining how they affect nervous systems, researchers can develop more specialized forms of treatment for phobias & other anxiety disorders Social anxiety disorder-irrational fear of being observed/evaluated or embarrassed in public, person can go out in public but prefers familiar places & routines ->ex. college student shows up to class right on time to avoid awkward convos with classmates he doesn’t know ->despite being hungry, student won’t go into cafeteria b/c roommate isn’t around, finds quiet spot in library & buys food from vending machine instead ->walking across campus, student sees prof approaching, not knowing if prof will recognize him, student gets anxious & pretends to stop & read text message to avoid contact Obsessive-compulsive disorder (OCD): characterized by unwanted, inappropriate & persistent thoughts (obsessions); repetitive stereotyped behaviours (compulsions); or combo of 2 ->typically onset occurs at young adulthood, obsessions can last for months to years -*recall that caudate region of brain seems to be responsible for constraining inappropriate impulses->compulsive behaviours ppl. with OCD engage in are thought to be way of asserting control over anxiety & impulses -compulsive behaviours often arise from specific obsessions ->ex. someone obsessively worried about starting fire might develop compulsive checking behaviours (double/triple check all electronics unplugged, turning off light repeatedly to ensure switch is fully off) -a difficult aspect of anxiety disorders is that they tend to be self-perpetuating: ->ex. young girl trying to pet neighbour’s cat but cat scratches her, years later girl feel nervous around cats->sight of cat triggers anxiety response, when cat is removed from situation, anxiety fades but process of reducing fear can actually reinforce phobia Mood Disorders Major depression-disorder marked by prolonged periods of sadness, feelings of worthlessness & hopelessness, social withdrawal & physical sluggishness ->cognition becomes depressed as well ->affected individ.’s have difficulty concentrating/making decisions while memories shit toward unhappy events ->physiologically: lethargic, sleepy & insomnia, change in appetite, digestive prob.’s (constipation) Bipolar disorder (maniac depression)-characterized by extreme highs & lows in mood, motivation & energy, shares many symptoms with depression (depression as unipolar) but occurs only 1/3 as often as depression ->involves depression on 1 end & mania (extremely energized, +ve mood) on other end ->b/c moods are so energetic, person doesn’t feel distress about mania until after it’s passed (which then they may feel great deal of guilt/embarrassment) ->ppl. with bipolar disorder move b/t both ends of continuum at different rates, some only experience few episodes while others several times a year, “rapid cyclers’ experience abrupt mood swings within hours -depression affects both cognition & emotion, depressive explanatory style: -twin studies suggest underlying genetic risk for developing major depression ->brain imaging research has ID’d 2 primary regions related to depression: 1. Limbic system-active in emotional responses/processing 2. Dorsal (back) of frontal cortex-concentrating & controlling thoughts ->overactive limbic system responds strongly to emotions & sends signals that lead to decrease in frontal lobe activity, reducing ability to concentrate & control thoughts -brain neurotransmitters (like serotonin, dopamine & norepinephrine) can increase risk of depression ->-ve emotions of depression co-occur with stress reactions throughout body, t/f involving endocrine system in disorder ->prolonged depression = higher risk for viral illnesses & heart disease -socioeconomic & enviro. factors can also leave ppl. more vulnerable to mood disorders, just living in specific neighbourhood can be risk factor for 3 reasons: 1. Poor neighbourhoods associated with higher daily stress levels (substandard housing, increased crime, lack of desirable businesses) 2. Ppl. in poor communities more vulnerable to stressors (unemployment, lack of connections) 3. Disrupted social ties more prevalent in poor communities, taking less interest in someone else’s well-being b/c of difficulty making rent (less home ownership) -another risk factor: ppl. who inherit “short” copies of gene responsible for serotonin activity are predisposed to depressive episodes in response to stress, prone to suicide attempts; those with “long copies” less prone (to depression) -in terms of suicide, it’s 4x more likely among males than females, 2-3x more likely in Native Americans & European Americans than other ethnicities ->suicide rates highest in elderly pop., 60% higher than rate for teens, but suicide leading cause of death in teen group Suicide Helplines -suicide prevention specialists equipped with active strategies to deal with distressed callers, problem-solving approach & active listening + empathy helps (depending on circumstances) ->1 time callers tend to benefit from active listeners (non-judgmental, reflective, compassionate), repeat callers benefit more if listener engages in problem-solving techniques 13.4 Schizophrenia -approx. 7.6/1000 adults experience schizophrenia at some point in their lives; writings from early history describe ppl. who seem to lose touch with reality, hear voice within & produce strange speech & behaviours->symptoms may have given rise to false beliefs of ppl. being possessed by demons/spirits Symptoms and Types of Schizophrenia Schizophrenia-refers to collection of disorders characterized by chronic & significant breaks from reality, lack of integration of thoughts & emotions, & serious prob.’s with attention & memory ->obvious sign of breaking from reality are hallucinations-false perceptions (of reality, such as hearing internal voices) ->delusions-false beliefs about reality, ex. person with schizo. may have delusion of grandeur (believing he/she is Jesus or the Pope) -schizo affects approx. 0.4-0.7% of world pop., men more likely to have schizo & tend to develop it earlier in life than women ->onset of schizo (in form of an acute psychotic episode) usu. occurs during late adolescence or young adulthood, subtle signs can also appear in toddlers -Subtypes: Paranoid schizophrenia-symptoms include delusional beliefs that one is being followed, watched or persecuted (may include delusions of grandeur) Disorganized schizophrenia-symptoms include thoughts, speech, behaviour & emotion poorly integrated & unclear, may also show inappropriate/unpredictable mannerisms Catatonic schizophrenia-symptoms include episodes in which person remains mute/immobile (sometimes in strange positions) for extended periods, may also show repetitive/pointless movements Undifferentiated schizophrenia-includes those who show combo of symptoms from more than 1 type of schizo. Residual schizophrenia-includes those who show schizo. symptoms but are either in transition to full-blown episode or in remission Positive symptoms-behaviours that should not occur (ex. confused, paranoid thinking & inappropriate emotional reactions), involve presence of maladaptive behaviour ->in contrast, negative symptoms-involve absence of adaptive behaviour (ex. absent or flat emotional reactions, lack of speech & motivation) -ppl. with schizo experience many problems with cognitive functioning, ranging from basic startle responses (ex. eye-blinking), to skills taking SAT’s ->prefrontal cortex plays big role in cognitive abilities, which show significant neurological decline in schizo ppl. (ex. *deficits in working memory->keeping track of thoughts, organizing convo sequence, handling multiple memory tasks) -social interaction is difficult, schizo ppl. show relatively poor social adjustment & poor reasoning about social situations ->emotional expressions/abilities (in reaction to other ppl.’s emotions) can be impaired ->ex. ppl. with schizo may maintain neutral expression on face & show little response to smiles from ppl. around them Schizophrenia Is Not a Sign of Violence or Genius -often misunderstood, many ppl. use schizo to mean “split personality disorder” but are actually referring to DID *(recall dissociative identity disorder) ->high profile cases that are generalized: Ted Kaczynski (bright mathematician became famous after sending mail bombs to researchers at many universities) & John Nash (math genius who has lived peaceful life as Princeton University Researcher), most schizo ppl. don’t pose a threat & having mental illness doesn’t mean genius ->few ppl. with schizo commit serious offenses, when violence does happen, there’s also substance abuse & other factors coming into play ->ppl. with mental illness are more likely to become crime victims (11x more likely than non-mentally ill), typically score slightly below avg. IQ scores Explaining Schizophrenia -in terms of genetics, studies using twin, adoption & family history methods have shown that as genetic relatedness increases, chance that relative of person with schizo will also develop disorder increases ->ex. if 1 identical twin has schizo, other twin has 25-50% chance of developing it, significantly higher than 10-17% rate found in fraternal twins -specific genes that contribute to schizo can’t be ID’d currently but scientists have discovered pattern of genetic irregularities found in 15% of ppl. with schizo, compared with 5% of healthy control (groups)->however since genetic abnormality not found in 85% of ppl., schizo can’t be diagnosed by testing for a single gene -a distinct neurological characteristic of schizo ppl. is shown in size of brain ventricles (fluid- filled spaces within brain core) ->ppl. with schizo have ventricular space 20-30% larger than those without schizo, large ventricular spaces = loss of brain matter, volume of entire brain is reduced by about 2% in schizo ppl. (small but significant difference)->reduced volume can be found in amygdala & hippocampus ->but rmb. those anatomical changes may not cause disorder but rather just tend to happen in those who have it -in terms of brain function, ppl. with schizo have been shown to have lower activity in frontal lobes (than those without schizo), those with long history of disorder show low levels of frontal lobe activity either when at resting state or when frontal lobes are activiated by cognitive tasks -imbalance in chemicals leads to disordered thinking & emotions, ppl. with schizo have overactive receptors for dopamine, excess dopamine can be involved in producing +ve symptoms of schizo (like hallucinations/delusions) but not –ve symptoms (like flattened emotion & lack of speech) -glutamate (another neurotransmitter) appears underactive in brain regions like hippocampus & frontal cortex of schizo ppl., those who ingest PCP drug (angel dust) can cause symptoms similar to those experienced by schizo ppl. -important observations: many ppl. who do not have mutant versions of genes (involved in schizo) can still develop disorder & identical twin has about 50% chance of developing schizo if twin has it ->as much as 10% of world pop. is at genetic risk for developing schizo -in terms of enviro. & prenatal factors, ppl. with schizo are (statistically) more likely to have been born in winter months b/c brain develops a lot during second 3 months (coinciding with flu season of wintertime births), also less exposure to sunlight perhaps? ->extreme stress, loss of spouse, exposure to war are other factors leading to schizo, psychologists t/f think maternal exposure to flu & fetal exposure to stress hormones may increase schizo risk -among many other contributing factors to schizo to take note of: psychotic symptoms from marijuana (interacting with genes involved in schizo), head injuries before age 10, psychosocial stress (poverty, unemployment, divorce, discrimination, urban enviro.’s) -in terms of cultural perspectives & influence on schizophrenia, ex. ethnicity affects experiences ppl. report having ->while Anglo-Americans tend to focus on mental experiences of schizo (disorganized thinking/emotions) & view mental disorders as seperate from other illnesses, Mexican Americans focus more on how schizo affects body (tension, tiredness) & conceive schizo like any other illness -Indonesian term “running amok” describes violent/out-of-control behaviour, similar to psychosis ->major difference: ex. common schizo symptom of Westerners is auditory hallucinations, but not prevalent in Indonesians (b/c of low use of speech in Indonesian culture) -the Swahili of Tanzania believe schizo is actually sign of spirits invading body, other cultures believe one’s self isn’t wholly separate but rather able to let in other entities/beings (external forces), spirits thought to overpower humans The Neurodevelopmental Hypothesis Neurodevelopmental hypothesis-irregular biological & enviro. factors interact during infant & child development to produce schizo symptoms ->in contrast to neurodegenerative hypothesis (brain deteriorates to produce schizo), neurodevelopmental hypothesis says that brain grows into schizophrenic state -neurodevelopmental hypothesis draws from research on genetics/prenatal factors although there’s much strength from behavioural evidence collected during childhood/adolescence ->ex. when psychologists viewed home movies of infants/children who eventually developed schizo, they noticed children showed unusual motor patterns (primarily on left side of body, jerking arm movements) in comparison to siblings who didn’t show such motor patterns -in adolescence, psychologists can detect schizo prodrome-collection of characteristics that resemble mild forms of schizo symptoms ->ex. teen might become more socially withdrawn & have some difficulty with depression/anxiety, but most complex problem includes experiences rep.’ing hallucinations/delusions (exception that person doesn’t fully believe them), teen might t/f say: “I seem to keep hearing my mother calling my name before I fall asleep, even when I know she isn’t home…” -although unusual body movements doesn’t indicate if child will develop schizophrenia, it’s still an irregular developmental pattern that can reflect neurological abnormalities, important idea that vulnerability to schizo present at birth -*importance: by ID’ing developmental patterns & catching them early, it’s possible to prevent schizo from developing or at least control its severity 14. 1 Treating Psychological Disorders Psychotherapy-processes for resolving personal, emotional, behavioural & social prob.’s to improve well-being -large scale surveys show growing # of Americans seeking help for psychological prob.’s -generally, women participate in psychotherapy more often than men & those 35-55 seek treatment more than younger adults & elderly ->Caucasians in U.S. more likely to seek treatment than African & Hispanic Americans ->ppl. in Canada & the U.S. more likely to seek therapy than most of world population (shown through research on college students all over the world) Barriers to Psychological Treatment -the 2 main obstacles to mental health treatment are time & expense, psychotherapy often costs $100+/hour, which it makes it difficult to afford for those without health insurance, many brand-name drugs to treat schizophrenia cost as much as $400/month ->time required can span several months through weekly sessions, indirect costs include time away from work, transport & possibly child care, lower-income families rather initiate treatment at hospital during emergency rather than scheduling appointment with psychologist ->to overcome these barriers, community org.’s provide psychotherapist offices in lower-income neighbourhoods, treatments have been made more affordable through generic products that can cost study: 99% of respondents said they’d seek mental health treatment if they believed it was helpful, t/f educational programs should be good enough to overcome obstacles ->limits to education: when ppl. believe psychological prob.’s are biological & unchangeable; they’re more likely to judge those who seek treatment than believing in psychosocial factors -*stigma (collection of –ve stereotypes) about mental health is also why many ppl. avoid psychotherapy, ex. consider someone who leaves work early once a week for therapy sessions to treat anxiety disorder, he/she would lean towards concealing purpose of leaving early & coworkers would be less likely to support him/her ->mental health stigmas affect adults’ decisions (about caring for own prob.’s) & decisions on behalf of their children; adults refuse treatment for children ->solution: being part of social group that actively supports psychological treatment -in terms of gender roles, men often go without treatment b/c masculine roles emphasize emotion
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