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Chapter 14 - Psychological Disorders

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incoherently, hallucinates, or has delusions, shows either little emotion or inappropriate emotion; or is socially withdrawn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