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Chapter 16

Chapter 16 – Psychological Disorders.docx

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Psychology 1000
Mark Cole

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Chapter 16 – Psychological Disorders Judgments of Abnormality: 1. Distress - Feeling anxious, depressed, and dissatisfied - Little control over actions 2. Dysfunctional - Interfere with a person’s work or relationships - No control over their behaviors 3. Deviant - Going against social norms - Go against laws Abnormal Behavior – behavior that is personally distressing, personally dysfunctional, and/or culturally deviant that other people judge it to be inappropriate Historical Perspective - Human societies have explained and responded to abnormal behavior in different ways at different times, based on their values and assumptions about human life and behavior - An ancient treatment was based on the notion that bizarre behavior reflected an evil spirits attempt to escape from a persons body o To release the evil spirit, they would use a procedure called trephination; they drilled a hole in the skull which let the spirit out - It was also seen that deviant people were possessed by the devil or had voluntarily made pacts with forces of darkness - Those identified as witches were thrown into a lake and if they sunk they were clean, but if they floated they were in trouble (executed) - Medical Model: symptoms will vanish when the pathogen is discovered and eliminated (still very popular) o Hippocrates suggested that mental illness were diseases like physical disorders (confusion was seen to be a disease) - Sigmund Freud: o Physical symptoms can have non-organic causes (symptoms serve the mind) o The functional paralysis of hysteria was seen to be only in women, until Freud proved that also men could have it as well  Hysteria involved paralyzed limbs where individuals believed they were paralyzed but actually weren’t o Thomas Szasz failed to ever find organic causes  They discovered that general paresis, a disorder involving bizarre behavior, resulted from massive brain deterioration caused from syphilis  Syphilis is actually a bacterial infection and could be treated through medication  He also found that since he could not prove there were organic causes, people were sent for treatment to be as “comfortable” as possible before they died  Szasz believed mental disorders are failures of adjustments to life and that their behaviors that define them are not symptoms but the problem (must help them stop what they are doing rather than trying to figure out why they are doing it) - Vulnerability-Stress Model - shows how each of us have some degree of vulnerability for developing a psychological disorder, given sufficient stress (children who grow up in a happy and loving family will be better at handling problems) o Vulnerability Factors:  Genetics, biological characteristics, psychological traits, maladaptive learning, and low social support o Stressors: trigger a disorder to be vulnerable  Economic adversity, environmental trauma, interpersonal stresses, and occupational setbacks DSM-IV- (Diagnostic and Statistical Manual of Mental Disorders 4 ) th - Emil Kraepelin created the first classification system of mental disorders - Contains detailed lists of observable behaviors that must be present in order for a diagnosis to be made - Categorical system: where people are placed within specific diagnostic categories (presently used and problematic because many people don’t fit into a specific category) - Dimensional system: relevant behaviors are rated along a severity measure (planned for DSM-V) - 5 Dimensions Axis 1: Primary Diagnosis - Ex) infancy and childhood disorders, organic mental disorders, substance- related disorders, schizophrenia, mood disorders, anxiety disorders, somatoform disorders, dissociative disorders, sexual and gender disorders, and eating disorders Axis 2: Personality/Developmental Disorders - Ex) personality disorders and mental retardation Axis 3: Relevant Physical Disorders - Ex) high blood pressure, diabetes, epilepsy Axis 4: Severity of Psychosocial Stressors and Environmental Stressors - Ex) mild = break-up or catastrophic = death or natural disaster Axis 5: Global Assessment of Level of Functioning - Ex) excellent = no evidence of any symptoms or poor = persistent danger to yourself or others Schizophrenia Schizophrenia – psychotic disorder that involves severe disturbances in thinking, speech, perception, emotion, and behavior - Thought, language, and emotion are all split apart - The most serious and difficult to treat Diagnosis: need to have 2 or more of the following for more than 30 days A: 1. Delusions – false beliefs that are sustained in the face of evidence that normally would be sufficient to destroy them 2. Hallucinations – false perceptions that have a compelling sense of reality 3. Disorganized speech and strange word choices 4. Very disorganized and catatonic behavior (don’t move for long periods of time) 5. Flattening of affect, alogia (not speaking) or avolition (not motivated) B: There must be social or occupational dysfunction C: Symptoms must last at least 3 months D: Other disorders and causes for the symptoms must be ruled out Specific Types: 1. Paranoid Type – delusions of persecution in which people believe the others mean to harm them, and delusions of grandeur, where they believe they are enormously important (suspicion, anxiety, anger) 2. Disorganized Type – confusion and incoherence with severe deterioration of adaptive behaviors, making it difficult to communicate with others (childish) 3. Catatonic Type – motor disturbances, waxy flexibility where their limbs can be moved into abnormal positions, oblivious to reality and agitated excitement where they can become dangerous 4. Undifferentiated Type – people who exhibit some of the symptoms above but do not fit a specific type Type 1 = positive symptoms - Delusions, hallucinations, and disordered speech and thinking - Pathological extremes of normal processes - Neurotransmitter problems - Likely to be associated with good functioning prior to breakdown and a better prognosis for eventual recovery o Respond well to drug therapy Type 2 = negative symptoms - Lack of emotions, loss of motivation, flattening of affect, catatonia, alogia, and absence of normal speech - Absence of normal reactions - Brain abnormalities - Likely to be associated with a history of poor functioning prior to hospitalization and with a poor outcome following treatment o Doesn’t respond well to drug therapy Onset, Course, and Stats: - Appears between late teens and early 30s - Complete recovery is rare and it usually will continue randomly throughout your lifetime - Prognosis is better when the onset is rapid (rapid change), the person is older, and premorbid (before) adjustment was good - 0.2-2.0% of people in the world have it - Equally common in males and females - Institutionalization is common and desirable Genetics: - It is 10 times greater to occur in first-degree relatives - 48% of monozygotic twins share the disorder and only 17% of dizygotic twins do (proving some genetic factors) - Environment still plays a major role since the concordance rate still isn’t 100% Neurotransmitters: - Effective drugs include Throanize and Haldol, since they block dopamine - Newer antipsychotics include Chozaril, Risperdal, and Zyprexia, since they black serotonin and dopamine receptors - Dopamine – major excitatory transmitter substance that, when having high levels of it, have trouble regulating emotional expression, motivated behavior and cognitive functioning Brain Structural Defects: - Enlarged ventricles - Abnormalities in the frontal lobes, temporal lobes and limbic system (influence cognitive processes and emotion) o Brain atrophy – a general loss or deterioration of neurons in the cerebral cortex and limbic system - The thalamus, which regulates and routes sensory info, also have abnormalities Sociocultural Factors: - Negatively correlated with economic class o Highest in lower economical populations o Social Causation Hypothesis - higher stress levels (poor) = more schizophrenia o Social Drift Hypothesis – as people develop schizophrenia, their personal functioning deteriorates so that they then become poor and end up in poverty - It is a culture-free disorder and is not any different around the world - Recent focus has been on the role of expressed emotion within families and how they live Major Mood Disorders Mood Disorders – involve depression and mania, excessive excitement - Mainly involve disorders of emotion or motivation - Characterized by manic and/or depressive episodes - Usually depressed people also experience an anxiety disorder - Episodes are NOT disorders but rather building blocks of disorders Diagnosis: must have 5 of the following for over 2 weeks (1 and 2 MUST be present) A: 1. Depressed mood most of the day, every day (motdned) 2. Loss of interest or pleasure in almost all activities (motdned) 3. Significant weight loss or grain (more than 5%/month) 4. Insomnia or hypersonmia 5. Psychomotor agitation or retardation 6. Fatigue 7. Feelings of worthlessness or excessive inappropriate guilt 8. Diminished ability to think or indecisiveness 9. Recurrent thoughts of death or suicide B: Symptoms cause significant distress or impairment in social and occupational function (hard to carry on as a normal person) C: Symptoms NOT due to direct effects of drugs or other medical conditions D: Symptoms NOT better accounted for bereavement (we grieve when something bad happens to us) Major Depressive Disorder (Unipolar): - Diagnosed when there is at least one depressive episode and no previous manic episode - 60% of people who end up having a depressive episode end up having another one - Leaves you unable to function normally and effectively in their lives - Feel blue, sad, discourages, aparathetic, and passive - No longer feel happiness in certain activities and have low self-esteem - Dysthymia – less dramatic effects on personal and occupational functioning, but lasts longer Onset, Course, and Stats for Major Depressive Disorders: - 10-25% lifetime incidence are with women - 5-12% lifetime incidence are with men o Men are more willing to tough things out and hide their feelings - 10-15% end up committing suicide - Usually occurs around age 20, but that is decreasing - Every time you have a depressive episode, there is a better change of you having another one - 10% suffer chronic depression (70% after third and 90% after fourth) Genetics for Major Depressive Disorders: - 1.5-3 times more common in first-degree relatives - 67% of monozygotic twins have it and only 15% of dizygotic twins have it - Still means there is some environmental factor and could be higher in identical twins because they grown up in a more similar environment Biological Factors: - Serotonin and norepinephrine are associated with major depression disorder when there is a shortage of both - The drugs that help with these disorders preserve their presence and their functions within the body - Serotonin and norepinephrine are found in the limbic system, which involves pleasure and reward o Low pleasure = low happiness Manic Episode: - Diagnosed when there is elevated, expansive or irritable mood for at least one week, social and occupational dysfunction, symptoms not due to stimulants, and at least three of the following: o Inflated self esteem (want to become things in life that are beyond your powers or skill level) o Decreased need for sleep o Excessive talkativeness o Flight of ideas or racing thoughts o Distractibility to unimportant details o Hyper goal-directed activity or psychomotor agitation (believing you can do a better job on your own) o Excessive pursuit of dangerous activities - Mania – a state of highly excited mood and behavior that is quite the opposite of depression Bipolar Disorder: - Depression alternates with periods of mania (doesn’t recognize any negative consequences or feelings) - Diagnosed when there is a single manic episode (with or without any depressive episodes) o A depressive episode usually follows a manic episode (they alternate randomly) o Depression is predominate in recurring episodes Onset, Course, and Stats for Bipolar Disorder: - Average age is 20s - 90% end up having a manic episode, followed by a depressive episode - However, if you have a depressive episode first, it is unlikely that you will have a manic episode - No sex difference - 5-10% of people with major depressive disorder develop bipolar disorder Genetics for Bipolar Disorders: - 10-15 times higher in first-degree relatives - Living in a depressing household could rub off on you as well so could also indicate an environmental facto
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