PSYCHOLOGICAL DISORDERS CHAPTER 15

ABNORMAL BEHAVIOR  Historical aspects of mental disorders  The medical model  What is abnormal behavior?  3 criteria  Deviant  Maladaptive  Causing personal distress  A continuum of normal/abnormal

PREVALENCE, CAUSES, AND COURSE  Epidemiology  Prevalence - % of population that displays the disorder during a specific period  Lifetime prevalence  Diagnosis  Etiology – causes  Prognosis

PSYCHODIAGNOSIS: THE CLASSIFICATION OF DISORDERS  American Psychiatric Association – published first taxonomy in 1952  Diagnostic and Statistical Manual of Mental Disorders – 4th ed. (DSM - IV)  Multiaxial system  5 axes or dimensions – F 14.3  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  DSM V – to be published in

Figure 14.4 – Example multiaxial evaluation

TWO MAJOR CLASSIFICATIONS IN THE DSM NEUROTIC DISORDERS Distressing but one can still function in society and act rationally. PSYCHOTIC DISORDERS Person loses contact with reality, experiences distorted perceptions.

AXIS I CLINICAL SYNDROMES AND AXIS II PERSONALITY DISORDERS  Anxiety Disorders  Somatoform Disorders  Dissociative Disorders  Mood Disorders  Schizophrenic Disorders  Eating Disorders  Axis II – Personality Disorders

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

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

CLINICAL SYNDROMES: SOMATOFORM DISORDERS  Somatization Disorder  Conversion Disorder  Hypochondriasis  Etiology  Reactive autonomic nervous system  Personality factors  Cognitive factors  The sick role

CLINICAL SYNDROMES: DISSOCIATIVE DISORDERS  Dissociative amnesia  Dissociative fugue  Dissociative identity disorder  Etiology  severe emotional trauma during childhood  Controversy  Media creation?  Sybil  Repressed memories

CLINICAL SYNDROMES: MOOD DISORDERS  Major depressive disorder  Dysthymic disorder  Bipolar disorder (manic-depressive disorder)  Cyclothymic disorder  Etiology  Age of onset – F  Genetic vulnerability – F  Neurochemical factors  Cognitive factors – negative thinking – F 14.15, F  Interpersonal roots  Precipitating stress

CLINICAL SYNDROMES: SCHIZOPHRENIA  General symptoms  Delusions and irrational thought  Deterioration of adaptive behavior - avolition  Hallucinations – any modality but usually auditory  Disturbed emotions – 66%  Prognostic factor  Gradual onset  Sudden onset

SUBTYPING OF SCHIZOPHRENIA 4 subtypes  Paranoid type  Catatonic type  Disorganized type  Undifferentiated type New model for classification  Positive vs. negative symptoms

ETIOLOGY OF SCHIZOPHRENIA  Genetic vulnerability  Neurochemical factors – Dopamine hypothesis  Structural abnormalities of the brain – prefrontal lobe and ventricles  The neurodevelopmental hypothesis  Expressed emotion  Precipitating stress – stress-vulnerability model

Figure The dopamine hypothesis as an explanation for schizophrenia

NEUROLOGICAL CHANGES IN SCHIZOPHRENIA

Figure – Neurodevelopment hypothesis of schizophrenia Figure – Expressed emotion and relapse rates in schizophrenia

Slide 33 – The stress-vulnerability model of schizophrenia

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  Prognosis

PSYCHOLOGICAL DISORDERS AND THE LAW  Insanity  M’naghten rule  The insanity defense  Involuntary commitment – varies by states  danger to self  danger to others  in need of treatment  Culture and pathology

EATING DISORDERS  Issues of weight  Anorexia nervosa  Criteria and subtypes: restrictive and binge/purge  Bulimia nervosa  Binge eating  History and prevalence  Age onset  Etiology  Genetics  Personality – perfectionism  Cultural issues - “perfect” body type and digital photograph  Family role  Cognitive factors

Figure Age of anorexia nervous in the United States – Lucas et al. (1991)