Chapter 14 - Psychological Disorders

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Psychological Disorders

Deviant, distressful and dysfunctional behaviour patterns

Attention-Deficit Hyperactivity Disorder (ADHD)

A psychological disorder marked by the appearance by age 7 of one or more of 3 key symptoms:
- extreme inattention
- hyperactivity
- impulsivity

- Toddlers who watch lots of TV are more likely to display symptoms at age 7

- Can be treated with non-addictive Ritalin and Adderall, which are stimulants, but can calm hyperactivity and increase ones ability to sit and focus on a task

- 4% of children and the appearance of the disorder occurs by age 7

Disordered Behaviours

Deviant and distressful behaviours are more likely to be considered disordered when also judged to be a harmful dysfunction.

- Ex. Interfering with leisure and work

Dysfunctional Behaviour

Dysfunction is the key to defining a disorder.

An intense fear of spiders may be deviant, but if it doesn't impair your life it is not a disorder

Medical Model

The concept that diseases, in this case psychological disorders, have physical causes that can be diagnosed, treated and in most cases, cured, often through treatment in a hospital.

A mental illness (psychopathology) needs to be diagnosed on the basis of its symptoms and cured through therapy, which may include hospital treatment in a psychiatric hospital

Behaviours

All behaviour arises from the interaction of nature and nurture

Susto

A condition marked by severe anxiety, restlessness and a fear of black magic in Latin America

Taijin-kyofusho

Social anxiety about ones appearance combined with a readiness to blush and a fear of eye contact (Japanese)

Schizophrenia

Talks incoherently, hallucinates, or has delusions, shows either little emotion or inappropriate emotion; or is socially withdrawn

Depression and schizophrenia = worldwide

DSM-IV-TR

- The American psychiatric associations Diagnostic and Statistical Manual of mental disorders, 4th edition, with an updated text revision

- A widely used system for classifying psychological disorders.
- Diagnosing, symptoms, illness.
- Developed in coordination with the 10th edition of the W.H.O.'s International Classification of Diseases (ICD-10) which covers both medical and psychological diseases

DSM-IV-TR Axis

- Axis 1 - is a Clinical Syndrome present?
- Axis 2 - is a personality disorder or mental retardation present?
- Axis 3 - is a General Medical Condition such as diabetes, hypertension or arthritis also present?
- Axis 4 - are psychosocial or environmental problems such as school or housing issues also present?
- Axis 5 - what is the global assessment of this person's functioning?

Adolescent Mood Swings

Bipolar Disorder

Oppositional Defiant Disorder

Temper tantrums, arguing, touchiness, spitefulness

un-DSM

A diagnostic manual of human strengths

Labels

Can serve as self-fulfilling prophecies

Anxiety Disorders

Psychological disorders characterized by distressing, persistent anxiety or maladaptive behaviours that reduce anxiety

Generalized Anxiety Disorder

An anxiety disorder in which a person is continually tense, apprehensive, and in a state of autonomic nervous system arousal

- 2/3 are women
- Concentration is difficult.
- Anxiety is free-floating.
- Leads to depression, ulcers, high blood pressure

Panic Disorder

An anxiety disorder marked by unpredictable minutes-long episodes of intense dread in which a person experiences terror and accompanying chest pain, choking, or other frightening sensations

- Symptoms seem like a heart attack
- Smokers risk is doubled, because nicotine is a stimulant

Phobias

An anxiety disorder marked by a persistent, irrational fear and avoidance of a specific object or situation

Specific Phobias

Animals, insects, heights etc

Social Phobia

Shyness to the extreme.

Intense fear of being scrutinized by others, avoid potentially embarrassing situations, such as speaking up, eating out, parties.

People will sweat, tremble, or have diarrhea

Agoraphobia

Fear or avoidance of situations in which escape might be difficult or help unavailable when panic strikes.

People may avoid being outside the home, in a crowd, on a bus or on an elevator

Obsessive Compulsive Disorder (OCD)

- An anxiety disorder characterized by unwanted repetitive thoughts (obsessions) and/or actions (compulsions)

- Cross the line between normality and disorder when they persistently interfere with everyday living and cause the person distress

- At some time during their life, 2-3% affected.
-Common amongst teens and young adults.
- 40 year study found that only 1/5 people fully recovered

Post-Traumatic Stress Disorder

- An anxiety disorder characterized by haunting memories, nightmares, social withdrawal, jumpy anxiety, and/or insomnia that lingers for four weeks or more after a traumatic experience

- The greater the emotional distress during a trauma, the higher the risk

- Our memories protect us in the future

Post-Traumatic Growth

Positive psychological changes as a result of struggling with extremely challenging circumstances and life crises, like cancer

Fear Conditioning

- Stimulus Generalization - occurs when a person attacked by a fierce dog develops a fear of all dogs

- Reinforcement - helps maintain our phobias, feeling anxious or fearing a panic attack, a person may go inside and be reinforced by feeling calmer

- Avoiding the feared situation reduces anxiety which reinforces the phobia.

Fearfulness in Families

Fearfulness runs in families.

Identical twins develop similar fears if raised separate

Anxiety Gene

Affects brain levels of serotonin which influences sleep and mood

Glutamate

- Neurotransmitter
- Brain's alarm centers become overactive

- Impaired glutamate activity appears to be another source of schizophrenia symptoms.

- Drugs that interfere with glutamate receptors produce schizophrenia negative symptoms.

Psychological Disorder Manifestation

Generalized anxiety attacks, panic attacks, PTSD, OCD are manifested biologically as an over arousal of brain areas involved in impulse control and habitual behaviours.

The anterior cingulated cortex, brain region that monitors our actions and checks for error, is hyperactive in those with OCD

Traumatic Experiences

Traumatic experiences can create fear circuits in the amygdala

Somatoform Disorders

Psychological disorder in which the symptoms take a somatic (bodily) form without apparent physical cause.

Conversion Disorder

A rare somatoform disorder in which a person experiences very specific genuine physical symptoms for which no physiological basis can be found.

Anxiety is converted into a physical symptom.

Lose sensation is specific parts, blindness, numbness etc.

Hypochondriasis

A somatoform disorder in which a person interprets normal physical sensations as a symptom of disease

Dissociative Disorders

Disorders in which conscious awareness becomes separated (dissociated) from previous memories, thoughts and feelings.

Loss of memory, change in identity in response to a stressful situation

Dissociated Identity Disorder (DID)

- A rare dissociative disorder in which a person exhibits two or more distinct and alternating personalities.
- (Multiple personality disorder).

- Patients are highly hypnotizable.
- Nonexistent in Japan and India.
- Symptoms are ways of dealing with anxiety

Mood Disorder

Psychological disorders characterized by emotional extremes.

(See major depressive disorder, mania, and bipolar disorder)

Major Depressive Disorder

- A mood disorder in which a person experiences, in the absence of drugs or a medical condition, two or more weeks of significantly depressed moods, feelings of worthlessness, and diminished interest or pleasure in most activities for more than 2 weeks

- Slows us down, defuses aggression, restrains risk taking

- Most major depressive episodes self-terminate. Therapy tends to speed recovery

Mania

- A mood disorder marked by a hyperactive, wildly optimistic state.

- Sometimes a rebound to depression.

- Free-flowing creativity, thinking. - Overtalkative, overactive, elated (though easily irritated if crossed), little need for sleep, fewer sexual inhibitions

Bipolar Disorder

A mood disorder in which a person alternates between the hopelessness and lethargy of depression and the overexcited state of mania.

Formerly called manic-depressive disorder

Norepinephrine

- Increases arousal and boosts mood is scarce during depression and overabundant during mania.

- Drugs that relieve mania reduce Norepinephrine.

- People with depression smoke -> nicotine -> stimulant -> increase norephinephrine, boost mood.

Serotonin

Scarce during depression

Drugs and Depression

- Drugs that relieve depression increase norepinephrine or serotonin by blocking their reuptake or their chemical breakdown.

- Repetitive exercise, jogging, reduces depression as it increases serotonin

- Boosting serotonin stimulates hippocampus neuron growth

Breakup With a Romantic Partner

o Stable - ill never get over this
o Global - without my partner I cant seem to do anything right
o Internal - our breakup was all my fault.
o Temporary - this is hard to take, but I will get through this
o Specific - I miss my partner but thankfully I have family & friends
o External - it takes 2 to make a relationship work, wasn't meant to be

Dysthymic Disorder

A persistently sad mood and low energy level

Depression and Schizophrenia

- If depression is the common cold, chronic schizophrenia is the cancer.

- Depression is the number one reason people seek mental health services.

1/100

Schizophrenia

- A group of severe disorders characterized by disorganized and delusional thinking, disturbed perceptions and inappropriate emotions and actions. Split from reality, not split personality

- Means split mind
- Schizophrenia typically strikes as young people mature into adulthood.
- Men - struck earlier, more severely, slightly more often
- Decline in the brain waves that reflect synchronized neural firing

Schizophrenia Symptoms

Positive symptoms are the presence of inappropriate behaviours; negative are the absence

Positive symptoms - hallucinations, talk in disorganized and deluded ways, and inappropriate laughter, tears or rage.

Negative symptoms - toneless voices, expressionless faces, mute or rigid bodies.

Subtypes of Schizophrenia

- Paranoid
- Disorganized Thoughts
- Disorganized
- Catatonic
- Undifferentiated
- Residual
- Chronic

Schizophrenia - Paranoid

Preoccupation with delusions or hallucinations, often with themes of persecution or grandiosity

Schizophrenia - Disorganized Thoughts

Selective attention is deficient, unable to ignore irrelevant stimuli

Schizophrenia - Disorganized

Disorganized speech or behaviour, flat or inappropriate emotion

Flat affect - Zombie like state, inappropriate emotion

Schizophrenia - Catatonic

Immobility, (or excessive purposeless movement), extreme negativism, and or parrotlike repeating of another's speech or movements

Schizophrenia - Undifferentiated

Many and varied symptoms

Schizophrenia - Residual

Withdrawal - after hallucinations and delusions have disappeared

Schizophrenia - Chronic and Acute

Chronic - Slow developing

Acute - Faster developing

- Acute Schizophrenia has a higher chance of recovery

Delusions

False beliefs, often of persecution or grandeur, that may accompany psychotic disorders.

May result from a breakdown in selective attention.

Hallucinations

A person with schizophrenia may have them.

Most likely auditory - voices, giving orders.

Dopamine Overactivity

Excessive dopamine receptors, 6x excess D4 dopamine receptor.

Such a high level may intensify brain signals creating positive symptoms such as hallucinations and paranoia.

Drugs that block dopamine receptors often lessen symptoms

Paranoia

Increased activity in the Amygdala (fear-processing centre)

Risk Factors That Cause Schizophrenia

- Low birth weight
- Oxygen deprivation during delivery
- Famine
- Fetal-virus infections

- Those born during winter and spring months after the fall-winter flu season are more likely. 5-8% increased risk

Personality Disorders

Psychological disorders characterized by inflexible and enduring behaviour patterns that impair social functioning

Antisocial Personality Disorder

- A personality disorder in which the person (usually a man) exhibits a lack of conscience for wrongdoing, even toward friends and family members.

- Lack of conscience becomes plain before 15, as they begin to lie, steal, fight, or display unrestrained sexual behaviour

- One half of all the children with lack of conscience before age 15 lie, steal, etc
- Early signs of antisocial behavior have been detected in children as young as ages 3-6


E.g. - May be aggressive and ruthless or a clever con artist

Avoidant Personality Disorder

Fearful sensitivity to rejection

Schizoid Personality Disorder

Eccentric behaviours, emotionless disengagement

Histrionic Personality Disorder

- Dramatic or impulsive behaviours
- Attention getting

Narcissistic Personality Disorder

Self focused

Genes of Antisocial Behaviour

The genes that put people at risk for antisocial behaviour, also put people at risk for substance abuse

Frontal Lobe Activity and Arousal

- Those with criminal conviction have lower levels of autonomic nervous system arousal

- Reduced activity in murderers frontal lobes - deficits in planning, organization and inhibition

- Violent repeat offenders have 11% less frontal lobe tissue than a normal brain.
- Explains why these people exhibit deficits in cognitive functions such as planning, organization, and inhibition

Diagnosable Disorders in Americans

26% of Americans suffer from a diagnosable disorder in a year

Suicides

Suicide rates are much higher among people who are wealthy, nonreligious, and unmarried

Women are much more likely than men to attempt suicide

White Americans are nearly twice as likely as Black Americans to kill themselves

Pinel

He insisted that madness was not demon possession but a sickness of the mind caused by severe stresses and inhumane conditions

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