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Chapter 14

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University of Toronto St. George
Ashley Waggoner Denton

CHAPTER 14. Psychological Disorders 12/18/2012 1:57:00 AM Tony Rosato, Capgras syndrome. HOW ARE PSYCHOLOGICAL DISORDERS CONCEPTUALIZED AND CLASSIFIED? *Psychological Disorders Are Classified into Categories etiology : factors that contributes to the development -Emil Kraepelin – categorize disorders by symptom -Diagnostic and Statistical Manual of Mental Disorders(DSM), in 1952 : remains the standard in psychology and psychiatry. Causes and symptoms. Through a multiaxial system. 1) clinical disorders 2) mental retardation or personality disorders 3) medical conditions 4) psychosocial problems 5) global or overall assessment of how well the person is functioning Now it‟s called DSM-IV-TR *Psychological Disorders Must Be Assessed -determining is not straight forward -through self-reports, observations, and interview. Assessment : examination of person‟s mental state through processes -To make diagnosis for the appropriate treatment (prognosis : probable outcome) : mental status exam (behavioral observation) in emergency situation, or clinical “interview” for ongoing participants seeking helps – interview important Structured Versus Unstructured Interview : quality of interview is up to the clinician‟s skill and experience. -Unstructured : highly flexible, dependent on interviewer -Structured : standardized questions. The diagnosis based on the specific patterns of responding. – Structured Clinical Interview for DSM (SCID) Types of Testing : Observation. -Psychological testing : Beck Depression Inventory. Minnesota Multiphasic Personality Inventory(MMPI) – 567 t/f items assessing emotions, thoughts, and behaviors, and ten clinical scales of mental disorder. -Problem of self-report assessments : to make a favorable impression respondents distort the truth or li outright. – to avoid „faking bad‟, validity scale is used. -Neuropsychological testing : the client performs actions testing abilities - > the quality of performance indicate problems. (difficulty changing from one rule to another may have frontal lobes problem.) -MRI, PET related with brain Evidence-Based Assessment : an approach to clinical evaluation in which research guides the evaluation of mental disorders, the selection of appropriate psychological tests and neuropsychological methods, and the use of critical thinking in making a diagnosis. -comorbidity : many mental disorders occur together Recognizing When Categories Represent Continuous Dimensions : Mental disorder is not all-or-none process. Could be just around normal, or really serious. *Dissociative Identity Disorder Is a Controversial Diagnosis -The Minds of Billy Milligan, criminal of rapes and robberies, claiming that he has DID with 24 personalities and he could not be held responsible. -Dissociative Identity Disorder ( DID ) called multiple personality disorder, and dissociative disorder category of DSM – involves disruptions of identity, of memory, and of conscious awareness. -abused in childhood -often have periods of amnesia, and sometime sonly one identity is aware of the others. -researchers skeptical whether it‟s genuine or they are faking, because DID patients has been increased after 1980s, and from criminals. -maybe therapists developed it during the sessions *Psychological Disorders Have Many Causes -The diathesis-stress model : an individual can have an underlying vulnerability or predispositions-diathesis, to a mental disorder. -the fetus, the prenatal problems, and all these biological factors : effects on the central nervous system. -neurological dysfunction -Structural imaging shows difference in brain anatomy b/w those with mental disorders and those without : biological factors and situational factors work together to reveal mental disorders. Bio-background, and situational-expression. Psychological Factors : In DSM first Ed, many disorders were described as reactions to enrvironmental conditions or as involving various defence machanisms. -The family systems model : an individual‟s behavior must be considered within a social context, particularly within the family. -Socio-cultural model : disorders are sometimes the result of the interactions between individuals and their cultures. Cognitive-Behavioural Factors : abnormal behavior is learned. -thoughts and beliefs are types of behavior and can be studied empirically Sex Difference in Mental Disorders : Internalizing disorders, those characterized by negative emotions such as distress and fear – more prevalent in females, and externalizing disorders, characterized by disinhibition, such as alcoholism, conduct disorders, and anti-social behavior are more prevalent in males. Culture and Mental Disorders : similarly universal, but there are some cultural aspects on mental disorders. -Cultural-bound syndrome, disorders mainly found in specific cultures or regions CAN ANXIETY BE THE ROOD OF SEEMINGLY DIFFERENT DISORDERS? Anxiety disorders – excessive anxiety in the absence of true danger. *There Are Different Types of Anxiety Disorders -atrophy in the hippocampus, even -chronic anxiety Phobic Disorders : phobia – a fear of a specific object or situation. -the fear is exaggerated and out of proportion to the actual danger. -Specific phobia, 1-8 ppl, particular objects and situations (flying, height, mother-in-law..) -Social phobia, called, social anxiety disorders, a fear of being negatively evaluated by others. Generalized Anxiety Disorders (GAD) : diffuse and always present. Worrying even about minor matters, and more present in women. Panic Disorder : twice in females. Sudden and overwhelming attacks of terror that seemingly come out of nowhere or are cued by external stimuli or internal thought processes. -agoraphobia : a fear of being in situations in which escape is difficult or impossible. Obsessive-Compulsive Disorder (OCD) : frequent intrusive thoughts and compulsive actions -more common in women -begins in early childhood -Obsessions are recurrent, intrusive, and unwanted thoughts or ideas or mental images -Compulsions are particular acts that the OCD patient feels driven to perform over and over again ( cleaning, checking, and counting). *Anxiety Disorders Have Cognitive, Situational, and Biological Components -Cognitive factors : non-threatening situation 을 threatening 으로 받아들여, 더 강력하게 기억하고 반응한다. 왜냐하면 그 상황이 위협이라면 큰 자극이니까. -Situational factors : 공포증이 있는 다른 사람을 관찰함으로써 생기는 자극. -Biological factors : inhibited in childhood – vulnerable to develop social phobia, and great activation of the amygdala(activated when threatened) : some aspects of childhood temperament are preserved in the adult brain. -people with OCD knows that their obsessions and compulsions are irrational, yet they are unable to stop them. -OCD results from conditioning, thereby to reduce their anxiety. -the etiology of OCD is in part genetic : genes that control the neurotransmitter glutamate, which is the major excitatory transmitter in the brain, causing increased neural firing. -Brain imaging : caudate is smaller and has structural abnormalities in people with OCD PET shows abnormal activity in thalamus and caudate in those with OCD People with disease in this area have symptoms of OCD – impulses leak into conscious, because this region is related to impulse supressions. Then, Prefrontal cortex, involved in conscious control of behavior, then becomes overactive in an effort to compensate. -deep brain electrical stimulation of this resion successful in alleviating the symptons of OCD -Environmental factor of OCD : streptococcal infection in some young children, auto immune system damaging the caudate, thereby producing the symptoms of OCD. Enhancing immune system treatment can diminish the symptoms of OCD with this syndrome. ARE MOOD DISORDERS EXTREME MANIFESTATIONS OF NORMAL MOODS? *There Are Different Types of Mood Disorders -Mood Disorders reflect extreme emotions :Depressive, Bipolar. Depressive Disorders : major depression – one of two symptoms, depressed or irritable mood or loss of interest in pleasurable activities. +appetite and weight changes, sleep disturbances, loss of energy, difficulty concentrating, feelings of self-reproach or guilt, and frequent thoughts of death and suicide. -only long-lasting episodes that impair a person‟s life. -A given 12-month period -women are nearly twice as likely to be diagnosed with major depression. -Dysthymia is of mild to moderate severity – not severe enough to diagnosed as depressive disorder. Depressed mood, more days than not depressed, continuing for at least 2 years. 2-20 years lasting, but typically 5-10 years. Maybe it‟s personality disorder, depressive personality. -sometimes called „the common cold of mental disorders‟, because of prevalence. -leading cause of disability -top causes of death -especially in developing country, cause they don‟t want to admit being mentally disordered. -Women in India, China, and esp. in rural Pakistan. -likely because of overwork and lack of support from several roles of women : more depression in them Bipolar Disorders : called manic depression, characterized by elevated mood, increased activity, diminished need for sleep, grandiose ideas, racing thoughts, and extreme distractibility. Much less common than depression. -episodes of mania -hypomanic episodes – not too disruptive in people‟s lives -equal in men and women. -emerges during late adolescence or early adulthood. -„An Unquiet Mind‟, Kay Redfield Jamison : helped shape the study of the disorder -Lithium, treatment for manic-depressive disorder, blunts positive feelings. -„Touched with Fire‟, she asks whether lithium would have dampened the genius of artists -the strong association between manic depression and artistic genius, *Mood Disorders Have Cognitive, Situational, and Biological Components -concordance rates : the percentage of twins who share the same disorder -genetic influence to depression, but weaker than to schizophrenia or to bipolar disorders -research on the Amish -successive generation – more sever, and early onset of diso
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