Chapter 15- Psychological Disorders 1

Question 1

Defining Psychological Disorders

Answer 1

different does not equal disorder

Question 2

Medical models

Answer 2

mental illnesses = medical illnesses
illness, diagnosis, and therapy or treatment of psychological disorders
medicine perspective-> treat it clinically

Question 3

Compendium de Psychiatrie

Answer 3

first published classification system of mental disorders
1883, Emil Kraepelin
biological nature of mental illness

Question 4

International Classification of Diseases (ICD)

Answer 4

classification of psychological disorders
published by world health organization
preferred in Europe + India
currently in 10th edition

Question 5

Diagnostic and Statistical Manual

Answer 5

first official classification system for diagnosing mental disorders in North America (US)
third edition -> away from theory and more on scientific evidence + clinical observation

Question 6

DSM-5

Answer 6

current edition, scientific evidence + clinical observations
North American perspective of psychological illness
goes beyond NA perspective-> consistent with international standards (like ICD) and talking about disorders in different countries
classifying disorders based on shared symptoms
defines mental disorder as a syndrome

Question 7

Mental disorder

Answer 7

is a syndrome: a set of related conditions of clinically significant disturbances of thoughts, feelings, or behaviours

Question 8

The 4 D’s for diagnosing behaviour as disordered:

Answer 8

Disturbance
Disfunction
Distress or Disability
Deviant***

Question 9

Disturbance

Answer 9

disturbance of thought, emotion, or behaviour
mental disorders are different from physical disorders that affect physiological and body processes
ex: person has hypothyroidism (underactive thyroid gland) may exhibit signs of depression
if depression due to hypothyroidism (physical disorder) -> diagnosis of major depression is NOT appropriate

Question 10

Disfunction

Answer 10

of biological or developmental processes
interferes with everyday functioning
ex: participating in everyday social relationships, holding a regular job, or being productive
sometimes its a risk to yourself + others

Question 11

Distress or Disability

Answer 11

in everyday life (especially in relationships + work)
leads to discomfort, pain, anguish
either in person or in others (especially family)
ex: why we say a person is “suffering” from a disorder

Question 12

Deviant**

Answer 12

thought, emotion, or behaviour
deviant = different from the norm/different from what most people do
but only if also dysfunctional
deviance alone is not enough
ex: Albert Einstein was deviant/different from the norm in his intelligence + creativity
but he was NOT suffering from a psychological disorder

Question 13

Notes on the 4 D’s

Answer 13

behaviours that possess only 1 or 2 of these 4 D’s -> not classified as disordered
if a behaviour is culturally accepted -> cannot be a disorder
ex: hallucinations of shamans

Question 14

DSM-5 describes __ major categories of disorder

Answer 14

22, covers +350 disorders

Question 15

Culture-bound syndromes

Answer 15

mental disorders found in certain cultures

ex: Southeast Asian cultures-> certain men suffer from koro
koro: belief that one’s genitals are retracting into one’s body

Middle East-> people suffer from zar
zar: the belief that they are possessed by spirits
run around in fits of laughter, shouting, singing

Question 16

Some disorders spread from culture to culture

Answer 16

anorexia was extremely rare in China-> fear of being fat wasn’t a symptom-> people that suffered complained of bloated tummy
Widely publicized case of anorexia in 1994 led to the death of a Hong Kong teen
rates of anorexia increased dramatically in China
increase in prevalence-> changed in symptoms of anorexia
Chinese anorexics complained mostly of their fear of being fat
disorder became westernized

Question 17

Controversy of the DSM-5

Answer 17

Classifying disorders based on shared symptoms
too many categories, may be old fashioned

DSM medicalizes normal behaviour
see psychology in the real world

Ignores biology
ignores that diseases should be classified by shared underlying biological factors
Five major psychiatric disorders
Autism spectrum disorder, ADHD, bipolar, depression, and schizophrenia have a common genetic cause
one general dimension/factor underlies all of the major psychological disorders

Mental disorders are not as distinct and different as the DSM-5 categories imply

Question 18

How Common Are Mental Disorders?

Answer 18

very common
2.8 million Canadians (1/10) have at least 1/6 mental or substance use disorders
Almost half (46%) of the adults in North America will suffer from at least one psychological disorder
More than half of people diagnoses will have 2+ disorders

Question 19

____ of people with psychological disorders do not seek out help

Answer 19

40%
due to the stigma: shame surrounding mental illness
Barriers: Embarrassment + discrimination

50% of people receiving treatment for depression were willing to tell their friends or bosses
+50% of those who suffered from mood, anxiety, or substance use disorders-> reported feeling embarrassed + faced discrimination

Question 20

Many Canadians hold negative attitudes towards people suffering from mental illness

Misconception + Reality

Answer 20

Misconception: People with psychological disorders are unstable + dangerous
Reality: Majority of people with a psychological disorder never commit violent acts -> more likely to be victims

Question 21

comorbidity

Answer 21

existence of 2 or more disorders at the same time

fear-based disorders (phobias + panic disorder) develop first -> predict the onset of other disorders later in life

Question 22

Is Overusing the Internet a Disorder?
People in South Korea starved their 3-month old to play an online fantasy game, Prius Online
In the parent’s version of Prius Online, they were raising a virtual baby

Answer 22

DSM-5 includes a category called “Internet Gaming Disorder”

due to lack of evidence-> its classified as a “Condition for Further Study”

Question 23

Internet Gaming Disorder/ A Condition for Further Study in DSM-5

Answer 23

Any 5 of 9 points must be present during a year period for diagnosis

Preoccupation with internet games (not internet gambling)
Withdrawal when games taken away (irritability, sadness, anxiety)
Tolerance (more time to be satisfied)
Unsuccessful attempts to stop/control habit
Loss of interest in previous hobbies + entertainment
Excessive use despite knowledge of their psychological problem
Deceives family, friends, and therapists about how much they play the game
Use of internet games to cope/escape negative mood
Jeopardized or loss of significant relationship, job, education due to internet activity

Some of these criteria are signs of addiction
tolerance, mood regulation, disruption of relationships, job, or school

Some people experience withdrawals (irritation or anger) when computer/smart phone is not available

Is this a real disorder or an example of “medicalizing” normal behaviour?

Question 24

Mobile addiction

Answer 24

excessive, impulsive checking and use of mobile device

especially in dangerous/illegal contexts (like driving)

Question 25

Overuse of mobile devices

Answer 25

has deleterious effects | impaired cognition and task performance while multitasking

Question 26

Neurodevelopmental Disorders (according to DSM-5)

Answer 26

psychological disorders prominent during childhood | include intellectual disabilities (formerly called mental retardation) and learning disabilities

Question 27

Subtypes of Neurodevelopment Disorders

Answer 27

ADHD ASD ASPERGERS Schizophrenia

Question 28

Attention deficit hyperactivity disorder (ADHD)

Answer 28

neuro-developmental disorder The inability to: focus attention for more than a few minutes remain still and quiet do careful work To be diagnosed-> need to display all symptoms before age 12 5% to 10% of North American school-age kids and 3-5% of children worldwide meet diagnostic criteria for ADHD Boys more likely to be diagnosed than girls at a ration of 2:1 ADHD begins in childhood -> continues into adulthood for 30%

Question 29

Autism spectrum disorder (ASD)

Answer 29

neuro-developmental disorder formerly known as Autism, autos=self severe language and social impairment repetitive habits inward focused behaviours extremely sensitive to sensory stimulation have trouble integrating multiple sources of sensory information (sight, sound, and touch) more interested in inanimate objects than in people + social activities Difficulty with joint attention believed to be over diagnosed-> rise is mostly due to increased awareness ASD encompasses a range of disorders, from severe disability to high functioning

Question 30

Joint attention

Answer 30

ability to make eye contact with others and to look in the same direction as someone else ex: if a mom points at something she's interested in kid with ASD is less likely to look in the same direction researchers who didn't know diagnoses were able to correctly diagnose ASD 77% of the time just based off watching their eye contact in 1st b-day home videos

Question 31

High functioning ASD

Answer 31

``` High functioning children have impaired social interest and skills restricted interests may be quite advanced in speech have above average intelligence ex: aspergers ```

Question 32

Asperger Syndrom

Answer 32

high functioning autism engaging adults in long winded + professorial (relating to professor aka really smart person) discussions on a narrow topic named based of Hans Asperger who first described it DSM-5 eliminated it as a separate diagnostic category people still idenify w/ it and call themselves “Aspies”

Question 33

Causes of Neurodevelopment Disorders

Answer 33

Neurodevelopmental disorders sometimes stem from genetic factors often remain latent (repressed) unless triggered by environmental condition

Question 34

Cause of ASD

Answer 34

Head size is an indicator of possible ASD brain is smaller than normal at birth grows much faster during first few years of life than the brains of non-autistic children abnormal rate of brain growth, due to genetics frontal lobes (processes social information) less connected in ASD children than normal kids amygdala in ASD kids is 13% larger Brain of a 5 year old with ASD = brain of 13 year old they got big ole brains

Question 35

Theory about the origin of ASD

Answer 35

based on mirror neurons mirror neurons fire both when a person performs a behaviour and when they see someone else performing that same behaviour involved in social behaviours: observational learning, imitation, language learning children with ASD deficient in these skills mirror neurons malfunction in kids with ASD

Question 36

Cause of ADHD

Answer 36

Environmental factor: if mother smokes while pregnant Genetic factor: smoking during pregnancy leads to conduct + impulse problems only if the child has 1/2 of the dopamine reputake transporter genes Prenatal smoke exposure + dopamine genotype alone is not significantly associated with increased behaviour disorders Environmental factor: excessive sugar consumption clinical studies do NOT support relationship between amount of sugar consumed + hyperactivity Brain activity of people with ADHD Low levels of brain activation Understimulated brain

Question 37

Contradictory effects of ADHD medication:

Answer 37

giving ADHD kids a stimulant to calm them down stimulant elevates their abnormally low nervous system activity require less stimulation and activity from environment

Question 38

psychotic disorders

Answer 38

disorders of thought and perception inability to distinguish between real and imagined perceptions ex: schizophrenia

Question 39

schizophrenia

Answer 39

involves profound disturbances in thought and emotion, specifically problems with perception ex: hallucinations “split mind” Emil Kraepelin 1890’s viewed disorder as a split from reality not a split attitude or split personality less common than depression if a first-degree relative (biological parent, sibling, or child) has the disorder, odds of a person having it rise to 10%

Question 40

Major Symptoms of Schizophrenia

Answer 40

Conditions At least two of the following symptoms must persist for one month At least one of the symptoms must come from the first three (delusions, hallucinations, or disorganized speech) ``` Symptoms of Schizophrenia Delusions Hallucinations Disorganized speech Grossly disorganized behaviour or catatonic behaviour immobile and unresponsive, though awake Negative symptoms not speaking or being unable to experience emotion ```

Question 41

The symptoms of schizophrenia fall into three major categories

Answer 41

Positive symptoms, negative symptoms, cognitive symptoms

Question 42

Positive symptoms

Answer 42

Positive Symptoms presence of abnormal thoughts and behaviours in people with schizophrenia (not seen in people without the disorder) addition of schizophrenic thoughts

Question 43

Examples of Positive Symptoms

Answer 43

Hallucinations convincing sensory experiences that occur in the absence of an external stimulus brain receives false sensory input experienced as real its not as if someone is talking to them hear voices, are convinced someone is living inside of them defining feature of psychosis auditory hallucinations are most common: hearing voices in head Brain activation during Hallucinations Activates the brain in similar (NOT IDENTICAL) to real external stimulation Delusions false beliefs or exaggerations despite evidence to the contrary ex: the idea one is a famous person/Jesus

Question 44

Similarities and differences between brain activation during hallucinations and brain activation during real external stimulation

Answer 44

Similarities: activation in: auditory cortex of temporal lobe during auditory hallucinations visual cortex of occipital lobe during visual hallucinations are similar to real auditory + visual stimuli Wernicke’s area activated (speech comprehension) Differences lack of activity in frontal lobes person is unable to monitor and determine source of images or sounds

Question 45

Negative Symptoms

Answer 45

absence of normal thoughts and behaviours | harder to diagnose and treat than +

Question 46

Examples of Negative Symptom

Answer 46

``` non responsiveness emotional flatness immobility striking of strange poses (catatonia) reduction of speaking inability to complete tasks ```

Question 47

Cognitive Symptoms

Answer 47

involves deficits in information processing | problems working memory, attention, verbal+ visual learning,

Question 48

Examples of Cognitive Symptoms

Answer 48

``` Problems with working memory attention verbal + visual learning memory reasoning problem solving speed of processing disordered speech speech follows grammatical rules, but content makes no sense ```

Question 49

Disordered Speech

Answer 49

word salad speech of people with schizophrenia may follow grammatical rules content makes no sense

Question 50

neologisms

Answer 50

making up new words in schizophrenic people

Question 51

Typical characteristic of Schizophrenia

Answer 51

Poor integration of perceptual processes People with schizophrenia have more trouble putting a fragmented image together and perceiving the picture as a whole

Question 52

diathesis-stress model

Answer 52

biological predispositions + stress/abusive environments = psychological disorders interaction between biology + environment

Question 53

There are two stages to the diathesis-stress model

Answer 53

Biological-genetic foundation/ Dispositon Environmental Event occurs after conception during critical point in development ex: maternal infection, chronic stress, use of drugs (weed + amphetamines)

Question 54

Explanations of Schizophrenia

Answer 54

Biology interacts with Environment (diathesis stress model) ``` Genetics schizophrenia is 70-85% due to genetics 19 genes contribute to schizophrenia Genes alone DO NOT CAUSE Schizophrenia one identical twin can have it, the other one might not ``` Environment more abuse + neglect children experience in early home lives-> more likely to suffer from schizophrenia later abuse + neglect during critical periods of brain growth and development-> smaller overall brain size and enlarged ventricles in middle of brain (butterfly shapes)

Question 55

Two major brain abnormalities characteristic of schizophrenia due to abusive environment

Answer 55

smaller overall brain size | enlarged ventricles in the middle of the brain

Question 56

Another explanation for schizophrenia

Answer 56

Biological Factors maternal infection brain neurochemistry

Question 57

Maternal Infection and Schizophrenia

Answer 57

``` Maternal infections Prenatal exposure to infections and diseases influenza rubella toxoplasmosis herpes ``` increased risk of schizophrenia and deficits in brain development effects don't exist during 1st and 2nd trimester of pregnancy (month 1 to month 6) higher immune cell activity in adult schizophrenic brains and people at risk

Question 58

Another explanation for schizophrenia

Answer 58

Abnormal brain development before birth -> schizophrenia

Question 59

Brain Abnormalities in Schizophrenics

Answer 59

Dysfunctional prefrontal cortex problems with working memory reduced and excessive activity in that area contains dysfunctional genes that regulate synapses Smaller hippocampus impairments in learning and memory formation Enlarged ventricles in the middle of the brain

Question 60

Problems in Communications between Neurons

Answer 60

People without schizophrenia neural networks in close groups orderly + chaotic firing of neurons essential for learning and memory ``` Schizophrenics Neural networks are: less clustered less efficient more disorderly *especially in frontal lobes ```

Question 61

Neurochemistry of Schizophrenia

Answer 61

prevailing view was the dopamine hypothesis

Question 62

Dopamine hypothesis

Answer 62

states that schizophrenics have an excess of dopamine in certain areas of brain

Question 63

Evidence of dopamine hypothesis

Answer 63

Amphetamines stimulate dopamine release and therefore may mimic hallucinations + delusions of schizophrenia amphetamines trigger symptoms Early antipsychotic drugs that block dopamine receptors are somewhat effective at treating positive symptoms

Question 64

Arvid Carlsson

Answer 64

discovered dopamine’s role in Schizophrenia + Parkinsons Nobel prize dopamine main NT involved in schizophrenia contributed to the dopamine hypothesis schizophrenia caused by excessive dopamine

Question 65

Problems with the dopamine hypothesis

Answer 65

Dopamine specific medications (tranquilizers) somewhat effectively treats only POSITIVE SYMPTOMS Minority of people who receive traditional drug treatment effectively manage their symptoms

Question 66

Drugs that led to schizophrenia that does not involve dopamine

Answer 66

PCP ketamine (animal tranquilizer) does not affect dopamine production block functioning of NT glutamate and its receptor NMDA

Question 67

Glutamate

Answer 67

major excitatory NT regulates dopamine crucial in learning, memory, neural processing, and brain development amplifies certain neural signals -> some stimuli more important than others crucial to selective attention

Question 68

Glutamate deficiencies

Answer 68

explains some symptoms of schizophrenia gene related to glutamate plays a role in schizophrenics prefrontal cortex functioning why some schizophrenics have trouble with selective attention, cognitive control, and working memory

Question 69

Depressive disorder (according to DSM-5)

Answer 69

disturbance in mood and emotion that prevents people from functioning effectively in everyday life highest order of the depressive orders contains all forms of depression several forms

Question 70

Major depressive disorder

Answer 70

long term low mood lack of motivation low energy

Question 71

Symptoms of Major Depressive Disorder

Answer 71

To be diagnosed with major depressive disorder, one must have at least 5/9 of the following symptoms for at least two consecutive weeks: Depressed mood that stays low all day for several days Reduced interest or pleasure in doing anything Significant change in body weight (dieting or overeating) Sleep disturbances Sluggishness or restlessness Daily fatigue or loss of energy Daily feelings of worthlessness, self reproach, or excessive guilt Lack of ability to concentrate or think clearly Recurrent thoughts of death or suicide Symptoms must impact daily functioning and be a source of distress

Question 72

Occurrence of major depressive disorder depends on __ and __

Answer 72

age and sex 3 times more likely in 18-29 year olds than in people +60 females experience it 2-3 times more than men Depression is the leading cause of disability worldwide

Question 73

Persistent depressive disorder (PAD)

Answer 73

form of depression same symptoms of major depressive disorder, but are mild intensity longer in duration (most of the day + time for 2 years)

Question 74

Most disabling aspect of depression

Answer 74

the lack of interest or ability to feel anything (positive or negative) rarely about feeling blue (sadness is the emotion most associated with depression)

Question 75

People with depression are at a higher risk of __

Answer 75

committing suicide

Question 76

Nature and Nurture Explanations of Depression

Answer 76

Depression is caused by a combination of brain chemistry and life circumstances Depression = brain chemistry + environment, aka diathesis-stress model

Question 77

Diathesis-stress view on the explanation of Depression

Answer 77

Stressful Environment abusive/extremely stressful environments -> increase risk of depression people who reported the worst childhood were more likely to be depressed than kids with no bad childhoods interacts with biological dispositions and personality traits to produce depression especially in people who have experience trauma/abuse/stress

Question 78

Stressful events

Answer 78

ex: social rejection: activates hypothalamic-pituitary-adrenal (HPA) system -> increases risk of depression stress causes accelerated aging of cells-> depression

Question 79

Experimental induced stress in animals

Answer 79

kills neurons in the hippocampus -> symptoms of depression