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Chapter 14 Psychological Disorders. Table of Contents a. APA Clinical Handbook b. Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) c.Physician's.

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Presentation on theme: "Chapter 14 Psychological Disorders. Table of Contents a. APA Clinical Handbook b. Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) c.Physician's."— Presentation transcript:

1 Chapter 14 Psychological Disorders

2 Table of Contents a. APA Clinical Handbook b. Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) c.Physician's Desk Reference (PDR) d.Encyclopedia of Psychological Disorders The system used by psychologists to classify psychological disorders is the:

3 Table of Contents a.a. recurrent, sudden and unexpected attacks of overwhelming anxiety b.b. enduring psychological disturbances attributed to the experience of a major traumatic event c.c. a chronic high level of anxiety d.d. persistent and irrational fear of an object or situation Posttraumatic stress disorder is characterized by

4 Table of Contents a.a. panic disorder b.b. conversion disorder c.c. generalized anxiety disorder d.d. phobic disorder Your friend's mother is afraid of squirrels. While she knows squirrels are basically harmless, she cannot control her anxiety when she sees either a real squirrel or a picture of a squirrel. She never took your friend to the local park when he was a child because of the numerous squirrels. Your friend's mother has:

5 Table of Contents ANSWERS: B B D

6 Table of Contents Rate this person using the following scale: 1= Basically OK Psychotherapy is not necessary 2=Mild Disturbance. Psychotherapy should be considered 3= Significant disturbance. Psychotherapy is definitely required 4= Severe disturbance. Hospitalize! Larry, a homosexual who has lived for three years with a man he met in graduate school, works as a psychologist in a large hospital. Although competent in his work, he often feels strained by the pressures of his demanding position. An added source of tension on the job is his not being able to confide in all his co workers about his private life. Most of his leisure activities are with good friends who belong to the gay subculture.

7 Table of Contents Rate this person using the following scale: 1= Basically OK Psychotherapy is not necessary 2=Mild Disturbance. Psychotherapy should be considered 3= Significant disturbance. Psychotherapy is definitely required 4= Severe disturbance. Hospitalize! Bob is a very intelligent, 25 year old member of a religious organization that is based on Buddhism. Bobs working for this organization caused considerable conflict between him and his parents, who are devout Catholics. Recently Bob experiences acute spells of nausea and fatigue that prevent him from working and which have forced him to return home to live with his parents. Various medical tests are being conducted, but as yet no physical causes of his problems have been found.

8 Table of Contents Rate this person using the following scale: 1= Basically OK Psychotherapy is not necessary 2=Mild Disturbance. Psychotherapy should be considered 3= Significant disturbance. Psychotherapy is definitely required 4= Severe disturbance. Hospitalize! Jim was vice president of the freshman class at a local college and played on the schools football team. Later that year he dropped out of these activities and gradually became more and more withdrawn from friends and family. Neglecting to shave and shower, he began to look dirty and unhealthy. He spent most of his time alone in his room and sometimes complained to his parents that he heard voices in the curtains and in the closet. In his sophomore year he dropped out of school entirely. With increasing anxiety and agitation, he began to worry that the Nazis were plotting to kill his family and kidnap him.

9 Table of Contents Rate this person using the following scale: 1= Basically OK Psychotherapy is not necessary 2=Mild Disturbance. Psychotherapy should be considered 3= Significant disturbance. Psychotherapy is definitely required 4= Severe disturbance. Hospitalize! Mary is a 30 year old musician who is very dedicated and successful in her work as a teacher in a local high school and as a part time member of local musical groups. Since her marriage five years ago, which ended in divorce after six months, she has dated very few men. She often worries that her time is running out for establishing a good relationship with a man, getting married, and raising a family. Her friends tell her that she gets way too anxious around men, and that she needs to relax a little in general.

10 Table of Contents Abnormal Behavior The medical model What is abnormal behavior? –3 criteria Deviant Maladaptive Causing personal distress A continuum of normal/abnormal diathesis-stress model –genetic predisposition to a disorder, and –poor environment (learning) in childhood, and –severe stress explains causality for disorders

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12 Prevalence, Causes, and Course Epidemiology - study of the distribution of mental or physical disorders in the population Prevalence Lifetime prevalence Diagnosis Etiology - refers to the apparent causation and developmental history of an illness Prognosis - is a forecast about the probable course of an illness

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14 Psychodiagnosis: The Classification of Disorders American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders – 4th ed. (DSM - 4) Multiaxial system 5 axes or dimensions –Axis I – Clinical Syndromes –Axis II – Personality Disorders or Mental Retardation –Axis III – General Medical Conditions –Axis IV – Psychosocial and Environmental Problems –Axis V – Global Assessment of Functioning

15 Table of Contents Figure 14.4 – Example multiaxial evaluation The DSM multiaxial system

16 Table of Contents Axis I Clinical Syndromes Discussed in Text Anxiety Disorders Somatoform Disorders Dissociative Disorders Mood Disorders Schizophrenic Disorders

17 Table of Contents Clinical Syndromes: Anxiety Disorders Generalized anxiety disorder –free-floating anxiety Phobic disorder –Specific focus of fear Panic disorder and agoraphobia –Physical symptoms of anxiety/leading to agoraphobia Obsessive compulsive disorder –Obsessions –Compulsions

18 Table of Contents Post-Traumatic Stress Disorder Post-Traumatic Stress Disorder Traumatic stress (experiencing or witnessing severely threatening, uncontrollable events with a sense of fear, helplessness, or horror) can produce PTSD, symptoms of which include haunting memories and nightmares, numbed social withdrawal, jumpy anxiety, and insomnia.

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20 Anxiety Disorders Common and uncommon fears

21 Table of Contents Anxiety Disorders

22 Table of Contents Anxiety Disorders PET Scan of brain of person with Obsessive/ Compulsive disorder High metabolic activity (red) in frontal lobe areas involved with directing attention

23 Table of Contents Etiology of Anxiety Disorders Biological factors –Genetic predisposition, anxiety sensitivity –GABA circuits in the brain Conditioning and learning –Acquired through classical conditioning or observational learning –Maintained through operant conditioning Cognitive factors –Judgments of perceived threat Personality –Neuroticism Stress –A precipitator

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28 a.a. emotional disturbances of varied kinds that may spill over to disrupt physical, perceptual, social, and thought processes b.b. delusions, hallucinations, disorganized speech, and deterioration of adaptive behavior c.c. physical ailments that cannot be fully explained by organic conditions d.d. feelings of excessive apprehension and worry Somatoform disorders are a class of psychological disorders characterized by

29 Table of Contents a.a. schizophrenic disorder b.b. dissociative identity disorder c.c. dissociative fugue d.d. dissociative amnesia The psychological disorder that involves the coexistence in one person of two or more largely complete, and usually very different, personalities is

30 Table of Contents a.a. bipolar disorder b.b. posttraumatic stress disorder c.c. schizophrenic disorder d.d. major depressive disorder The psychological disorder characterized by separate episodes of depression and mania is

31 Table of Contents ANSWERS: C B A

32 Table of Contents Clinical Syndromes: Somatoform Disorders Somatization Disorder - is marked by a history of diverse physical complaints that appear to be psychological in origin. They occur mostly in women and often coexist with depression and anxiety disorders. Conversion Disorder - significant loss of physical function (with no apparent organic basis), usually in a single organ system…loss of vision, partial paralysis, mutism, etc…glove anesthesia, for example, is neurologically impossible. Hypochondriasis - excessive preoccupation with health concerns and incessant worry about developing physical illnesses. –Etiology Reactive autonomic nervous system Personality factors Cognitive factors The sick role

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34 Clinical Syndromes: Dissociative Disorders Dissociative amnesia - sudden loss of memory for important personal information that is too extensive to be due to normal forgetting. Memory loss may be for a single traumatic event or for an extended time period around the event Dissociative fugue - is when people lose their memory for their entire lives along with their sense of personal identity…forget their name, family, where they live, etc., but still know how to do math and drive a car Dissociative identity disorder –Etiology severe emotional trauma during childhood –Controversy Media creation?

35 Table of Contents Clinical Syndromes: Mood Disorders Major depressive disorder –Dysthymic disorder Bipolar disorder (manic-depressive disorder) –Cyclothymic disorder Etiology –Genetic vulnerability –Neurochemical factors - norepinephrine and serotonin synapses –Cognitive factors - pessimistic explanatory –Interpersonal roots - poor social skills –Precipitating stress –2X as high in women

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42 a.a. delusions b.b. hallucinations c.c. disturbed emotions d.d. irrational thought Larry frequently hears his daughter's stuffed animals talking about him when he is in the hallway outside his daughter's bedroom; Larry is experiencing

43 Table of Contents a.a. mood disorders b.b. schizophrenic disorders c.c. anxiety disorders d.d. somatoform disorders The presence of structural abnormalities in the brain that are assumed to reflect deterioration of brain tissue has been associated with

44 Table of Contents a.a. neurological damage during prenatal development b.b. excessive levels of the neurotransmitter dopamine c.c. structural abnormalities in the brain d.d. inadequate social skills Which of the following has not been proposed as a factor associated with the development of schizophrenic disorders?

45 Table of Contents ANSWERS: B B D

46 Table of Contents Clinical Syndromes: Schizophrenia General symptoms –Delusions and irrational thought –Disorganized speech (word salad) and thinking –Deterioration of adaptive behavior –Hallucinations –Disturbed emotions and reality –Psychomotor disturbances (stupor, rigidity, waxy flexibility, posturing, parroting) Prognostic factors - A more favorable prognosis exists when the onset of the disorder is sudden and at a later age, the individuals social and work adjustment was good prior to onset, the proportion of negative symptoms is low, and the patient has a good social support system

47 Table of Contents Subtyping of Schizophrenia 4 subtypes –Paranoid type - delusions –Catatonic type - muscular rigidity, random activity –Disorganized type - incoherence, social withdrawal –Undifferentiated type – doesnt fit neatly in one of the above New model for classification –Positive vs. negative symptoms Negative means taking away behaviors that were present –ex. - no emotions (flat affect), inappropriate emotions, ambivalence Positive means adding behaviors that were not already present –ex..- hallucinations, delusions

48 Table of Contents Schizophrenia Delusions false beliefs, often of persecution or grandeur, that may accompany psychotic disorders In a psychiatrist's waiting room two patients are having a conversation. One says to the other, "Why are you here?" The second answers, "I'm Napoleon, so the doctor told me to come here." The first is curious and asks, "How do you know that you're Napoleon?" The second responds, "God told me I was." At this point, a patient on the other side of the room shouts, "NO I DIDN'T!"

49 Table of Contents Symptoms of Schizophrenia Delusions of persecution –theyre out to get me –paranoia Delusions of grandeur –God complex –megalomania Delusions of being controlled –the CIA is controlling my brain with a radio signal

50 Table of Contents Etiology of Schizophrenia Genetic vulnerability – high genetic predisposition - it runs in families - twin studies show high correlation for identical twins vs. fraternal Neurochemical factors – dopamine receptors are overactive which means an excess of dopamine Brain structure– enlarged ventricles The neurodevelopmental hypothesis - asserts that it is attributable to disruptions in maturational processes of the brain before or at the time of birth that are caused by prenatal viral infections or malnutrition, obstetrical complications, and other brain insults. Psychoactive medication – work by lowering levels of dopamine – prolonged use has side effects, ex. tremors, seizures, restlessness, weight gain, slow mental functioning, losing sense of self, blurred vision, or tardive dyskinesia - an incurable neurological disorder marked by involuntary writhing and ticklike movements of the mouth, tongue, face, hands, or feet.

51 Table of Contents Schizophrenia

52 Table of Contents Frequency of positive and negative symptoms in individuals at the time they were hospitalized for schizophrenia. Source: Based on data reported in Andreasen & Flaum, 1991.

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54 Disorganized Thinking

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56 Schizophrenia

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59 Dissociative Identity Disorder Originally known as multiple personality disorder 2 or more distinct personalities manifested by the same person at different times VERY rare and controversial disorder Examples include Sybil, Trudy Chase, Chris Sizemore (Eve) Has been tried as a criminal defense Nonpsychotic disorder, do not respond to meds memory loss

60 Table of Contents Dissociative Identity Disorder Pattern typically starts prior to age 10 (childhood) Most people with disorder are women Most report recall of torture or sexual abuse as children and show symptoms of PTSD

61 Table of Contents Causes of Dissociative Disorders? Repeated, severe sexual or physical abuse. However, many abused people do not develop DID Combine abuse with biological predisposition toward dissociation? –people with DID are easier to hypnotize than others –may begin as series of hypnotic trances to cope with abusive situations

62 Table of Contents The DID Controversy Some curious statistics –1930–60: 2 cases per decade in USA –1980s: 20,000 cases reported –many more cases in US than elsewhere –varies by therapistsome see none, others see a lot Is DID the result of suggestion by therapist and acting by patient?

63 Table of Contents Personality Disorders Anxious-fearful cluster –Avoidant, dependent, obsessive-compulsive Dramatic-impulsive cluster –Histrionic, narcissistic, borderline, antisocial Odd-eccentric cluster –Schizoid, schizotypal, paranoid Etiology –Genetic predispositions, inadequate socialization in dysfunctional families

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65 Psychological Disorders and the Law Insanity –Mnaghten rule - mental disorder makes a person unable to distinguish right from wrong Involuntary commitment –danger to self –danger to others –in need of treatment

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67 Culture and Pathology Cultural variations Culture bound disorders –Koro –Windigo –Anorexia nervosa

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